Difluprednate achieves a similar clinical outcome after trabeculectomy compared to prednisolone acetate at a significantly lower drop frequency.

Background: The success of trabeculectomy is highly dependent on postoperative control of inflammation and fibrosis. Prednisolone acetate is the most commonly used topical steroid after ophthalmic surgery. However, non-compliance and adherence problems are constantly thwarting this goal. A topical eye drop regimen that requires fewer drops per day and still achieves the same success rates regarding controlling fibrosis and inflammation is desirable. Objective: This study aimed to evaluate whether similar success rates can be achieved with topical difluprednate, comparable to prednisolone acetate, following trabeculectomy. Design: A single-center, single-surgeon retrospective chart review. Methods: Retrospectively, medical records were evaluated. Inclusion criteria were age ⩾18 years with no upper limit and a diagnosis of open-angle glaucoma. Exclusion criteria were follow-up of <3 months and a history of a concurrent surgery that lowers IOP other than laser trabeculoplasty, cataract surgery, or trabecular meshwork bypass procedures. Success was defined as IOP ⩽ 21 mmHg and ⩾20% reduction below baseline after 1 month, no hypotony (IOP > 5 mmHg), no subsequent glaucoma surgery, and no loss of light perception vision. Primary outcome measures were time to failure and Kaplan-Meier survival, and secondary outcome measures were change in IOP, number of anti-glaucoma medications (AGM), and postoperative interventions and complications. Results: In all, 115 eyes were analyzed: 75 eyes in the prednisolone acetate group, and 40 eyes in the difluprednate group. Baseline characteristics and demographics were similar between the groups. IOP and AGM were significantly lowered, with no difference between the two groups. Failure rates varied between 12% and 31% at 1 year in the prednisolone arm, and between 12% and 35% in the difluprednate arm. No differences between the two treatment arms were found regarding survival statistics. Conclusion: There was no difference in the success rate between the drug used to treat postoperative inflammation and prevent scarring after trabeculectomy. However, fewer drops per day were necessary in the difluprednate group. Both groups showed no difference in the amount by which IOP and AGM were reduced.