Early add-on ibuprofen after trabeculectomy may reduce risk of bleb failure in high-risk patients

Singapore: A new study revealed that early use of oral Ibuprofen is safe as an adjunct to reduce intraocular pressure and the likelihood of bleb failure in individuals who have a high chance of post-trabeculectomy scarring and improve trabeculectomy survival. The study results were published in the Journal of Glaucoma.

The most popular and gold-standard incisional surgical procedure for glaucoma is trabeculectomy. It reduces intraocular pressure (IOP), which is a major modifiable risk factor. Long-term surgical success lies in wound healing as excessive inflammation causes scarring and eventual bleb failure. Past literature shows uncertain results on the effectiveness of NSAIDs in reducing bleb failure after trabeculectomy. Hence researchers conducted a study to evaluate the effectiveness of early adjunctive oral Ibuprofen for reducing intraocular pressure and bleb failure in eyes at high risk of failure, compared with eyes not administered ibuprofen.

A retrospective analysis was carried out on patients who had primary glaucoma and underwent trabeculectomy/phaco trabeculectomy at the Singapore National Eye Centre between April 2020 and April 2021. Nearly 288 eyes of 273 patients with a mean ± SD age of 68.56 ± 10.47 years and 32.60% females were enrolled in the study. They were followed up for a duration of≥1 year. Of the total, 77 (26.7%) eyes that were deemed to be at high risk of scarring were administered oral ibuprofen ≥3 months postoperatively (mean ± SD ibuprofen administration duration: 4.08 ± 2.28 wk). Participants’ IOPs at baseline and postoperative weeks 1, 2–3; and months 1, 2, 3, 6, and 12 were recorded. Bleb failure was considered when 2 consecutive IOP readings of >21, >18, and >15 mm Hg were recorded, and/or required remedial postoperative laser or surgery.

Key findings:

• The ibuprofen group experienced significantly greater postoperative IOP reductions at week 1 [95%CI: −2.89 mm Hg] and month 1 [−2.29 mm Hg].
• There were significantly lower odds of bleb failure at the >18 mm Hg [95% CI: 0.39] and >15 mm Hg [0.52] thresholds, compared with the non-ibuprofen group.
• There were no observable differences in adverse ocular hypotony events.

Thus, the use of adjunctive oral ibuprofen in patients at high risk of early bleb failure post trabeculectomy resulted in greater levels of IOP reduction and a reduced likelihood of experiencing bleb failure up to a year.

Further reading: Sim JJL, Man REK, Foo RCM, et al. Oral Ibuprofen is Associated With Reduced Likelihood of Early Bleb Failure After Trabeculectomy in High-Risk Glaucoma Patients. J Glaucoma. 2023;32(4):237-244. doi:10.1097/IJG.0000000000002188