Adherence to Frequent Postoperative Eye Drops High After Trabeculectomy

Elyse J. McGlumphy, MD

New findings suggest an adherence to frequent postoperative corticosteroid eye drops was high in patients with primary open-angle or angle-closure glaucoma after trabeculectomy.

Study investigators added that adherence to the topical drops can successfully be monitored remotely within this patient population.

“Surgical success was greater among eyes with nearly ideal adherence and was poorer in older persons and those with more advanced glaucoma,” wrote study author Elyse J. McGlumphy, MD, Assistant Professor of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medicine.

In order to compare electronically measured adherence with topical corticosteroid drops and outcomes of glaucoma surgery, the prospective cohort study included eyes undergoing surgery from August 2019 to January 2021. All eyes were followed for up to 1 year.

Patients were recruited from the Glaucoma Center of Excellence at the Wilmer Eye Institute. The eligibility criteria included primary open-angle or angle-closure glaucoma, were aged ≥18 years, and underwent trabeculectomy (with or without cataract surgery) or tube-shunt implantation.

Regarding study methods, patients were instructed on the use of an eye drop monitoring device (Kali Drop). The participants were informed that it would be utilized to record postoperative corticosteroid instillation in real time.

The main study outcomes included the adherence to a regimen of corticosteroid eye drops during the first 5 postoperative weeks, achievement of target intraocular pressure (IOP) at 6 weeks and 6 months to 1 year after surgery, and bleb morphology at 1 year.

From a total of 90 patients, data show the adherence was 89.7% ± 13.7% overall and 80.9% ± 15.8% during dosing every 2 hours. The target IOP was achieved at the final visit (6 months or 1 year) in 81% (59 or 73) without reoperation.

Moreover, eyes with a higher ratio of drops taken versus prescribed were identified to be significantly more likely to achieve target IOP at 6 months or 1 year (P = .05).

Investigators noted that total adherence was better in younger patients, eyes with less field loss, and patients of one particular surgeon (P <.03). Data suggest patient adherence during dosing every 2 hours was higher in eyes with a higher target IOP (P = .01).

There was no observed adherence outcome significantly related to race, sex, bleb morphology, postoperative pain, or postoperative anterior chamber inflammation.

McGlumphy and colleagues added that adherence values did not significantly correlate with adherence questionnaire data (predicted mean, 78% ± 17%; actual mean, 91% ± 13%; P <.001).

The study, “Electronically Monitored Corticosteroid Eye Drop Adherence after Trabeculectomy Compared to Surgical Success,” was published in Ophthalmology Glaucoma.