Effect of Topical Corticosteroids on Early Postoperative Intraocular Pressure Following Combined Cataract and Trabecular Microbypass Surgery

Purpose: To evaluate the early postoperative outcomes of trabecular micro-bypass stents and concomitant cataract surgery (TMS-CS) with and without postoperative corticosteroid therapy. Methods: Prospective, interventional matched, consecutive case series comparing outcomes of open-angle glaucoma patients who underwent TMS-CS with and without postoperative corticosteroid therapy. Primary outcome was intraocular pressure (IOP) changes up to 6 months postoperatively and the secondary outcomes included number of postoperative medications, IOP spikes, peripheral anterior synechia (PAS), and best-corrected visual acuity improvements. Results: The clinical outcomes of 97 eyes-49 in the steroid group age- and IOP-matched with 48 in the nonsteroid group-were analyzed. Baseline IOP in steroid and nonsteroid groups were 16.22 +/- 3.98 and 16.04 +/- 3.99 (P = 0.822), respectively. Both IOP and number of antiglaucoma medications significantly decreased postoperatively (P < 0.001), however, there were no group differences at different time points (P = 0.653 and P = 0.168, respectively). At 1 week postoperatively, the steroid group had higher number of IOP spikes (n = 9) compared with nonsteroid group (n = 2, P = 0.022). There was no significant difference in postoperative PAS between the steroid group (n = 6) and nonsteroid group (n = 6, P = 0.970). Vision improved significantly postoperatively (P < 0.001) with no group differences at different time points (P = 0.322). Conclusions: TMS-CS decreased IOP and number of antiglaucoma medications while improving visual acuity both with and without the use of postoperative steroids. Limiting the use of postoperative steroids in combined microbypass stents and cataract surgery appears to be a safe surgical option and may help minimize acute elevations in IOP in the early postoperative period.