Oral ibuprofen is associated with reduced likelihood of early bleb failure following trabeculectomy in high-risk glaucoma patients.

Abstract

Individuals prescribed ibuprofen post-trabeculectomy have a better post-operative intraocular pressure control and higher chance of bleb survival despite being at a higher risk of scarring. To investigate the effects of early adjunctive oral ibuprofen treatment on intraocular pressure (IOP) and bleb failure in eyes at high risk of scarring. In these retrospective analyses, 288 eyes of 273 patients (mean±SD age: 68.56±10.47y; 32.60% females) with primary glaucoma who underwent trabeculectomy/phacotrabeculectomy at the Singapore National Eye Centre between April 2020 to April 2021 with a follow-up duration ≥1 year were included. Of these, 77 (26.7%) eyes deemed to be at high risk of scarring were administered oral ibuprofen ≥3 months post-operatively (mean±SD ibuprofen administration duration: 4.08±2.28wk). Participants' IOPs at baseline and at post-operative weeks 1, 2-3; and months 1, 2, 3, 6, and 12 were recorded. Bleb failure was defined as two consecutive IOP readings of >21, >18 and >15mmHg, and/or requiring remedial post-operative laser or surgery. The ibuprofen group experienced significantly greater post-operative IOP reductions at week 1 (mean difference [95% confidence interval]: -2.89 [-5.22, -0.56] mmHg) and month 1 (-2.29 [-4.53, -0.05] mmHg); and substantially lower odds of bleb failure at the >18mmHg (odds ratio [95% confidence interval]: 0.39 [0.20-0.79]) and >15mmHg (0.52 [0.29-0.94]) thresholds, compared to the non-ibuprofen group. No differences in adverse ocular hypotony events were observed. Early adjunctive oral ibuprofen administered to individuals at high risk of post-trabeculectomy scarring is associated with greater IOP reductions and reduced likelihood of bleb failure. Our results suggest that oral NSAIDs may be a safe way of improving trabeculectomy survival in high risk eyes.