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Corticosteroids Versus NSAIDs on Intraocular Pressure and the Hypertensive Phase After Ahmed Glaucoma Valve Surgery

Yuen, Darana MD, FRCSC*; Buys, Yvonne MD, FRCSC*; Jin, Ya-Ping MD, PhD; Alasbali, Tariq MD; Smith, Michael MBChB, FRCOphth§; Trope, Graham E. MB, PhD*

doi: 10.1097/IJG.0b013e3181efbec0
Original Studies

Purpose To compare the effect of topical steroids versus nonsteroidal anti-inflammatory drugs on intraocular pressure (IOP) and the hypertensive phase (HP) after Ahmed glaucoma valve surgery.

Patients and Methods Prospective, randomized, double-masked controlled trial. Twenty-eight consecutive consenting patients scheduled for Ahmed glaucoma valve surgery were randomized to receive either postoperative topical dexamethasone or ketorolac. The main outcome measure was IOP. Secondary outcomes included incidence of HP, visual acuity, number of glaucoma medications, postoperative complications, and subsequent procedures.

Results The mean postoperative IOP (in mm Hg) in the ketorolac versus dexamethasone arms respectively was as follows: 8.8±4.7 versus 10.0±4.5 at week 1 (P=0.500); 10.7±6.7 versus 17.5±10.4 at week 2 (P=0.053); 11.0±6.5 versus 18.0±7.3 at week 4 (P=0.013); 14.8±8.6 versus 17.5±5.2 at week 6 to 8 (P=0.323); and 14.8±9.6 versus 17.8±7.5 at week 10 to 12 (P=0.374). Four patients (31%) in the ketorolac arm versus 8 patients (53%) in the dexamethasone arm exhibited the HP (P=0.276). Wound leak was the most severe complication and there were 3 cases (23%) in the ketorolac group versus nil in the steroid group (P=0.087). Conjunctival retraction was observed in 8 patients (62%) in the ketorolac arm versus 2 patients (13%) in the dexamethasone arm (P=0.016).

Conclusions Mean IOP was greater at all time points postoperatively in the steroid group with the difference between groups statistically significant at week 4. The nonsteroidal anti-inflammatory drug group showed greater wound-healing problems.

*Department of Ophthalmology and Visual Sciences, Toronto Western Hospital

Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

Department of Ophthalmology, King Faisal University, Dammam, Saudi Arabia

§Department of Ophthalmology, Royal Devon and Exeter Hospital, Exeter, United Kingdom

Sources of Support: Toronto Western Hospital Department of Ophthalmology (internal departmental funding).

Disclosure: The authors declare no conflict of interest.

Reprints: Graham E. Trope, MB, PhD, Toronto Western Hospital, 399 Bathurst Street, East Wing 6-411, Toronto, Ontario M5 T 2S8, Canada (e-mail:

Received January 31, 2010

Accepted June 27, 2010

© 2011 Lippincott Williams & Wilkins, Inc.