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This prospective randomized controlled trial aimed to compare the efficacy and safety of topical preservative-free diclofenac (DICLO) to dexamethasone (DEX) eyedrops, and their combination (DEX+DICLO) after trabeculectomy. Sixty-nine patients with medically uncontrolled glaucoma were randomized to receive topical postoperative treatment with DICLO (n = 23), DEX (n = 23), or a combination of DEX and DICLO (n = 23). The primary outcome was the intraocular pressure (IOP) 12 months postoperatively. Secondary outcomes included surgical success, failure, visual field, and visual acuity from baseline to 12 months postoperatively. IOP reached the lowest point one day after trabeculectomy. At 12 months, IOP was 10.0 mmHg (95% CI, 8.4–11.6 mmHg) for DICLO, 10.9 mmHg (95% CI, 9.4–12.3 mmHg) for DEX, and 11.2 mmHg (95% CI, 9.1–13.3 mmHg) for DEX+DICLO. There were no significant differences in IOP, surgical success, failure, visual field, or visual acuity between the DICLO, DEX, or DEX+DICLO groups. We found that topical diclofenac was not statistically different from topical dexamethasone in controlling IOP 12 months after trabeculectomy. Combining diclofenac and dexamethasone offered no added IOP control compared to dexamethasone alone.

This prospective randomized controlled trial aimed to compare the efficacy and safety of topical preservative-free diclofenac (DICLO) to dexamethasone (DEX) eyedrops, and their combination (DEX+DICLO) after trabeculectomy. Sixty-nine patients with medically uncontrolled glaucoma were randomized to receive topical postoperative treatment with DICLO (n = 23), DEX (n = 23), or a combination of DEX and DICLO (n = 23). The primary outcome was the intraocular pressure (IOP) 12 months postoperatively. Secondary outcomes included surgical success, failure, visual field, and visual acuity from baseline to 12 months postoperatively. IOP reached the lowest point one day after trabeculectomy. At 12 months, IOP was 10.0 mmHg (95% CI, 8.4–11.6 mmHg) for DICLO, 10.9 mmHg (95% CI, 9.4–12.3 mmHg) for DEX, and 11.2 mmHg (95% CI, 9.1–13.3 mmHg) for DEX+DICLO. There were no significant differences in IOP, surgical success, failure, visual field, or visual acuity between the DICLO, DEX, or DEX+DICLO groups. We found that topical diclofenac was not statistically different from topical dexamethasone in controlling IOP 12 months after trabeculectomy. Combining diclofenac and dexamethasone offered no added IOP control compared to dexamethasone alone.

Introduction: To compare the effect of three different anti-inflammatory regimens consisting of preservative-free dexamethasone (DEX), diclofenac (DICLO) eye drops, and their combination (DEX + DICLO) following trabeculectomy on early postoperative inflammation. Methods: A prospective randomized controlled trial. Sixty-nine patients undergoing trabeculectomy were randomized to receive either postoperative treatment with topical DEX (n = 23), topical DICLO (n = 23), or a combination of topical DEX and topical DICLO (n = 23) after trabeculectomy. The primary outcome was the anterior chamber flare measurement in the first 3 months postoperatively. Secondary outcomes included intraocular pressure, central corneal thickness, conjunctival injection, and number of cells in the anterior chamber from baseline to 3 months postoperatively. Results: Anterior chamber flare reached a maximum 1 day after trabeculectomy with an increase of 55% (95% CI 37–73%) for DEX, 64% (95% CI 47–82%) for DICLO, and 57% (95% CI 39–75%) for DEX + DICLO and returned to near pre-operative values 6 weeks after surgery. There were no significant differences in anterior chamber flare [effect size for DICLO: 0.16 (95% CI − 4.3 to 4.6), effect size for DEX + DICLO: 0.09 (95% CI − 4.1 to 4.3)], intraocular pressure, central corneal thickness, conjunctival injection, or number of cells in the anterior chamber between DEX, DICLO, or DEX + DICLO groups. Conclusion: We found that topical diclofenac was not statistically different from topical dexamethasone in controlling early postoperative inflammation after trabeculectomy, while combining diclofenac and dexamethasone offered no added anti-inflammatory control compared to dexamethasone alone. Trial Registration: www.clinicaltrials.gov (NCT04054830).

This prospective randomized controlled trial aimed to compare changes in intraocular pressure in three different anti-inflammatory regimens following trabeculectomy. Sixty-nine patients were randomized to receive either postoperative prophylaxis with topical preservative-free dexamethasone (DEX), diclofenac (DICLO), or their combination (DEX+DICLO). Our main outcome measure was an intraocular pressure (IOP) change of a minimum 4 mmHg following the withdrawal of anti-inflammatory prophylaxis 9 weeks after trabeculectomy. We found that the IOP decreased ≥ 4 mmHg in 18.6% of eyes after cessation of the topical steroid DEX (n = 3/22) and DEX+DICLO (n = 5/21), whereas a decrease in IOP was not observed in the DICLO group. In conclusion, IOP decreased in nearly 1/5 of patients after cessation of topical steroidal anti-inflammatory prophylaxis after trabeculectomy. This points toward a steroid-induced increase in IOP even after trabeculectomy. Thus, increased postoperative IOP may be related to steroid use, and the success or failure of a trabeculectomy cannot be fully evaluated before anti-inflammatory prophylaxis with steroids is stopped or changed to non-steroidal eye drops.

There is no consensus on the surgical management of coexisting cataract in patients who undergo glaucoma surgery. In this study, we systematically reviewed the literature to compare the efficacy and safety of phacotrabeculectomy and trabeculectomy either alone or followed by later phacoemulsification. We systematically searched the literature databases PubMed/MEDLINE, EMBASE, and the Cochrane Central. Eligible studies were comparative trials of eyes with glaucoma that underwent either phacotrabeculectomy or trabeculectomy with or without later phacoemulsification. Our primary outcome measure was intraocular pressure (IOP) control closest to 12 months. Secondary outcome measures were efficacy closest to 12 months in terms of visual acuity, visual field, prevalence of complications, needling or revision, number of antiglaucomatous medications, and surgical success. We identified 25 studies with a total of 4,749 eyes. The IOP did not differ significantly between those who underwent phacotrabeculectomy versus trabeculectomy with (MD: 0.63, CI95%: -0.32, 1.59, p=0.19) or without later phacoemulsification (MD: -0.52, CI95%: -1.45, 0.40, p=0.27). However, phacotrabeculectomy was associated with lower risk of complications (RR: 0.80, CI95%: 0.67, 0.95, p=0.01) and better visual acuity corresponding to a 1.4-line difference (MD: -0.14, CI95%: -0.27, -0.95, p=0.03) compared to trabeculectomy. Other secondary outcome measures did not differ significantly (visual field, needling or revision, number of antiglaucomatous medications, and surgical success). In conclusion, postoperative IOP is comparable, and the number of complications is lower when phacotrabeculectomy is compared to trabeculectomy with or without later phacoemulsification in patients with coexisting glaucoma and cataract. However, our study also reveals that the level of evidence is low, and randomized clinical trials are warranted.