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David C. Broadway, MD, FRCOphth; Ian Grierson, PhD; Jörg Stürmer, MD; Roger A. Hitchings, FRCOphth

Arch Ophthalmol. 1996;114(3):262-267.

Abstract
Objective
To determine whether the adverse effects of antiglaucoma medications could be reversed before filtration surgery, potentially reducing the risk of subsequent failure.

Methods
One month before surgery, 30 patients who were receiving multiple antiglaucoma medications underwent an inferior bulbar conjunctival biopsy, ceased using sympathomimetic drops, and began treatment with topical corticosteroid, (1% fluorometholone four times daily). At the time of surgery two conjunctival biopsy specimens were obtained, one from the operation site (superior bulbar region), and one from the inferior bulbar region. The biopsy specimens were quantitatively analyzed by light microscopy. In addition, the outcome of first trabeculectomy for 16 of these patients was compared with that of 16 matched patients who had not undergone an altered preoperative regimen of topical therapy.

Results
During a 1-month period a notable decrease occurred in the number of fibroblasts and inflammatory cells throughout the conjunctiva. Inferior bulbar conjunctiva was found to be representative of superior bulbar conjunctiva with respect to these changes. Furthermore, evidence comparing the matched patients suggested that the altered preoperative regimen may have improved the success rate of trabeculectomy.

Conclusions
The preoperative regimen used reversed the adverse conjunctival effect of topical medication. The regimen may be of clinical benefit in improving the success rate of trabeculectomy.

Author Affiliations
From Moorfields Eye Hospital (Drs Broadway, Stürmer, and Hitchings) and the Department of Clinical Science, Institute of Ophthalmology (Drs Broadway, Grierson, and Stürmer), London, England; and the Ophthalmology Unit, Department of Medicine, Liverpool (England) University (Dr Grierson).

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