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Incidence of steroid response in microinvasive glaucoma surgery with trabecular microbypass stent and ab interno trabeculectomy

      Abstract

      Objective

      To determine the incidence and risk factors for steroid response in patients undergoing combined phacoemulsification cataract extraction (PCE) and microinvasive glaucoma surgery with either trabecular microbypass stent implantation (iStent) or ab interno trabeculectomy (Trabectome).

      Design

      Retrospective, noncomparative, single-institutional observational chart review.

      Participants

      Consecutive patients with open-angle glaucoma who underwent PCE with iStent or Trabectome with 3 months of follow-up.

      Methods

      Data were collected from patient charts, including pre- and postoperative intraocular pressure (IOP) following application of topical corticosteroid on postoperative visits for at least 3 months. A steroid response was defined as an IOP rise of greater than 5 mm Hg beginning at least 3 days after surgery with no other obvious explanation and with IOP < 20 mm Hg following rapid tapering or withdrawal of the steroid.

      Results

      A total of 118 eyes from 89 patients, average age of 71.4 ±12.1 years, were included. Overall, a steroid response was seen in 12.7% of eyes (n = 15), and no difference was noted between Trabectome (11.8%) and iStent (13.6%, p = 0.782) eyes. Axial length (AL; p = 0.01), younger age (p = 0.009), traumatic glaucoma (p = 0.004), and normal-tension glaucoma (NTG; p = 0.0048) were significant predictors of steroid response in a multivariate analysis. In eyes with AL ≥ 25 mm, the steroid response rate was 40%, in contrast to eyes with AL < 25 mm, where it was 10.2%.

      Conclusion

      A steroid response develops in approximately 1 in 8 patients undergoing PCE with Trabectome or iStent. Young age, AL > 25 mm, traumatic glaucoma, and NTG were found to be significant predictors of steroid response.

      Résumé

      Objectif

      Déterminer l'incidence et les facteurs de risque d'une réaction aux stéroïdes chez des patients qui subissent une chirurgie de la cataracte avec phacoémulsification (CCPE) associée à une chirurgie du glaucome micro-invasive (CGMI) reposant soit sur l'implantation d'un micro-stent de pontage trabéculaire (iStent) ou sur une trabéculectomie ab interno (Trabectome).

      Nature

      Examen rétrospectif et non comparatif de dossiers médicaux réalisé dans un seul centre.

      Participants

      Patients consécutifs présentant un glaucome à angle ouvert qui ont subi une CCPE s'accompagnant de l'implantation d'un iStent ou d'un appareil Trabectome pour lesquels on disposait d'un suivi de 3 mois.

      Méthodes

      Les données tirées des dossiers des patients comprenaient la pression intraoculaire (PIO) pré- et postopératoire après l'instillation d'un corticostéroïde topique lors des visites postopératoires pendant au moins 3 mois. Une réaction aux stéroïdes se définissait comme suit : hausse de la PIO de plus de 5 mm Hg débutant au moins 3 jours après l'intervention en l'absence d'autre explication évidente et PIO < 20 mm Hg après la baisse rapide de la dose du stéroïde ou l'arrêt de son administration.

      Résultats

      Au total, 118 yeux de 89 patients, dont l’âge moyen était de 71,4 ± 12,1 ans, ont été inclus dans l’étude. Dans l'ensemble, il s'est produit une réaction aux stéroïdes dans 12,7 % des yeux (n = 15); aucune différence n'a été enregistrée entre les groupes Trabectome (11,8 %) et iStent (13,6 %; p = 0,782). La longueur axiale (LA; p = 0,01), le jeune âge (p = 0,009), le glaucome post-traumatique (p = 0,004) et le glaucome à pression normale (GPN; p = 0,0048) étaient des facteurs de prédiction significatifs d'une réaction aux stéroïdes selon l'analyse multivariée. Le taux de réaction aux stéroïdes était de 40 % dans les yeux dont la LA était ≥ 25 mm, et de 10,2 % dans les yeux dont la LA était < 25 mm.

      Conclusion

      Une réaction aux stéroïdes apparaît chez environ 1 patient sur 8 ayant subi une CCPE (sans égard à l'implant, Trabectome ou iStent). On a observé que le jeune âge, une LA ≥ 25 mm, le glaucome post-traumatique et le GPN étaient des facteurs de prédiction significatifs d'une réaction aux stéroïdes.
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