Reversal of topical antiglaucoma medication effects on the conjunctiva
D. C. Broadway, I. Grierson, J. Sturmer and R. A. Hitchings
Moorfields Eye Hospital, London, England.
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.
