In this retrospective cohort study, 288 eyes of 273 patients (mean ±SD age: 68.56 ±10.47 y; 32.60% females) with primary glaucoma who underwent trabeculectomy / phacotrabeculectomy at the Singapore National Eye Centre between April 2020 and April 2021 with a follow-up duration ≥1 year were included. Seventy-seven (26.7%) eyes which were deemed to be at high risk of scarring within three months post op were administered oral ibuprofen 400mg three times daily for at least a week (mean ±SD ibuprofen administration duration: 4.08 ±2.28 weeks). The study defined bleb failure as two consecutive IOP readings of >21, >18, and >15mmHg, and / or requiring remedial postoperative laser or surgery. The ibuprofen group experienced significantly greater postoperative IOP reductions at week one [mean difference, 95%CI: −2.89 (−5.22, −0.56)mmHg] and month one [−2.29 (−4.53, −0.05)mmHg]; and substantially lower odds of bleb failure at the >18mmHg [odds ratio, 95% CI: 0.39 (0.20-0.79)] and >15mmHg [0.52 (0.29-0.94)] thresholds, compared with the non-ibuprofen group. The authors found no differences in adverse ocular hypotony events and concluded that early adjunctive oral ibuprofen administered for patients with a high risk of post-trabeculectomy scarring is associated with greater IOP reductions and reduced likelihood of bleb failure. In summary, consider oral nonsteroidal anti-inflammatory drugs (NSAIDs) for high risk trabeculectomies, but it is important to be mindful of adverse effects and close monitoring is recommended.
Oral Ibuprofen is associated with reduced likelihood of early bleb failure after trabeculectomy in high-risk glaucoma patients.
Sim JJL, Man REK, Foo RCM, et al.
JOURNAL OF GLAUCOMA
2023;32(4):237-44.
