Selective Laser Trabeculoplasty: NSAIDs vs Steroids in Post-Operative Management Jennifer Calafati MD, Donna Williams-Lyn PhD, Iqbal Ike K. Ahmed MD, FRCSC Authors have no financial interest

Background Either Argon Laser Trabeculoplasty (ALT) or Selective Laser Trabeculoplasty (SLT) may be performed to lower a patient’s intraocular pressure (IOP). Either Argon Laser Trabeculoplasty (ALT) or Selective Laser Trabeculoplasty (SLT) may be performed to lower a patient’s intraocular pressure (IOP). There are major differences between SLT and ALT (energy density, pulse duration, target cells). There are major differences between SLT and ALT (energy density, pulse duration, target cells). These differences have subsequently promoted SLT as the popular choice in glaucoma laser treatment in recent years. These differences have subsequently promoted SLT as the popular choice in glaucoma laser treatment in recent years. Following SLT, it is expected that patients experience some degree of post-operative inflammation (marked by the presence of anterior chamber (AC) cells, flare and hyperemia) as well as a transient rise in IOP. Following SLT, it is expected that patients experience some degree of post-operative inflammation (marked by the presence of anterior chamber (AC) cells, flare and hyperemia) as well as a transient rise in IOP. While it is an option to simply observe patients post-laser, an effort to control these side effects is often made using pharmacotherapy in order to foster patient comfort. While it is an option to simply observe patients post-laser, an effort to control these side effects is often made using pharmacotherapy in order to foster patient comfort. Established studies examining these therapies pertain mostly to ALT, and from these investigations it is evident that the best management of these post-operative challenges remains an area of both conflict and uncertainty. Established studies examining these therapies pertain mostly to ALT, and from these investigations it is evident that the best management of these post-operative challenges remains an area of both conflict and uncertainty.

Purpose Current research is limited regarding the use of NSAIDs versus corticosteroids following SLT. Current research is limited regarding the use of NSAIDs versus corticosteroids following SLT. Hence, we propose an investigation of this issue, comparing the use of an NSAID, diclofenac sodium 0.1% ophthalmic solution (Voltaren Ophthalmic, Novartis Ophthalmics) with a topical corticosteroid, prednisolone acetate 1% (Pred Forte 1%, Allergan, Inc.) following selective laser trabeculoplasty. Hence, we propose an investigation of this issue, comparing the use of an NSAID, diclofenac sodium 0.1% ophthalmic solution (Voltaren Ophthalmic, Novartis Ophthalmics) with a topical corticosteroid, prednisolone acetate 1% (Pred Forte 1%, Allergan, Inc.) following selective laser trabeculoplasty. Selected outcome measures for our analysis are inflammation (measured by anterior chamber cells, flare and hyperemia) as well as IOP control at 6 months and 1 year. Selected outcome measures for our analysis are inflammation (measured by anterior chamber cells, flare and hyperemia) as well as IOP control at 6 months and 1 year.

Methods This is a randomized, multi-center, prospective, double-blind, active-control study. This is a randomized, multi-center, prospective, double-blind, active-control study. Seventy-seven study participants were enrolled, with 40 patients receiving topical NSAID (Voltaren) and 37 patients receiving topical Steroid (PredForte) four times daily for a duration of four days following SLT. Seventy-seven study participants were enrolled, with 40 patients receiving topical NSAID (Voltaren) and 37 patients receiving topical Steroid (PredForte) four times daily for a duration of four days following SLT. Primary study outcomes were IOP and inflammation (as measured by AC cells, flare and hyperemia). Outcomes were investigated and recorded pre- operatively and post-operatively at 1 hr, 4-7 days, 1 month, 3 month and at 6 month follow-ups. Primary study outcomes were IOP and inflammation (as measured by AC cells, flare and hyperemia). Outcomes were investigated and recorded pre- operatively and post-operatively at 1 hr, 4-7 days, 1 month, 3 month and at 6 month follow-ups. The number and identity of all glaucoma medications was also documented at each visit, as was a patient pain score, a representation of patient comfort. The number and identity of all glaucoma medications was also documented at each visit, as was a patient pain score, a representation of patient comfort. IOP’s throughout the study period were compared between the two groups using a Kaplan-Meier Survival Analysis. Success for the analysis required the fulfillment of at least one of the following conditions: 1) a 20% drop from pre- operative IOP; 2) if there was an increase in IOP, it must not be > 2mmHg and must be in the absence of any additional glaucoma medications or laser/surgical procedures. IOP’s throughout the study period were compared between the two groups using a Kaplan-Meier Survival Analysis. Success for the analysis required the fulfillment of at least one of the following conditions: 1) a 20% drop from pre- operative IOP; 2) if there was an increase in IOP, it must not be > 2mmHg and must be in the absence of any additional glaucoma medications or laser/surgical procedures.

Results

Results

Results * The difference between the Steroid and the NSAID survival curves is not statistically significant in the KM survival curve (p>0.05) Kaplan-Meier Survival Analysis

Results

Results

Conclusion Both steroids and NSAIDs can be considered equally successful treatment options for IOP control following selective laser trabeculoplasty. Both steroids and NSAIDs can be considered equally successful treatment options for IOP control following selective laser trabeculoplasty. Both steroids and NSAIDs can be considered equally successful treatment options for the management of inflammation following selective laser trabeculoplasty. Both steroids and NSAIDs can be considered equally successful treatment options for the management of inflammation following selective laser trabeculoplasty. Patient comfort (as reflected by patient-reported pain scores) is satisfactory with both therapies. Patient comfort (as reflected by patient-reported pain scores) is satisfactory with both therapies.

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