Kahook et al Figure 1 Triamcinolone acetonide is injected using a blunt cannula prior to conjunctival closure. The cannula is inserted in the hub and the steroid depot is injected in the retrobulbar space. Figure 2 Two interrupted 9-0 vicryl sutures reapproximate the conjunctiva at the end of the case. visual acuity ranging between 20/20 and 20/100. Preoperative diagnosis included 12 patients with primary open angle glaucoma, one with uveitic glaucoma, and one with con- genital glaucoma. Thirteen patients had failed previous trabeculectomy with MMC and one had previous goniotomy at six months of age. Mean preoperative hypotensive drop use was 3.0 ± 0.68. IOP decreased from a preoperative level of 26.43 ± 8.32 to 10.64 ± 1.82 at six months (p 0.001). The decrease in IOP was statistically signiﬁcant at all time points (Table 1) and all patients remained off hypotensive drops for the duration of follow up. Three patients lost one line of vision attributed to cataract progression while the remaining 11 patients experienced no change in visual acuity. The patient with uveitic glaucoma was considered a treatment failure after IOP increased to 22 mm Hg three months post-operatively. He required a bleb needling procedure with MMC and remains off hypotensive drops with an IOP of 8 after six months of follow-up. There were no cases of postoperative bleb leak, infection, hypotony or conjunctival ulceration. Discussion Pre- and postoperative use of steroids has been reported in patients undergoing trabeculectomy.4,5 Araujo and colleagues reported on the effects of postoperative corticosteroids on IOP and clinical course.4 They found that patients who received postoperative steroids were less likely to have higher IOP’s, 30 less likely to need further glaucoma surgery, and required less glaucoma medicines for IOP control. Giangiacomo and colleagues reported the use of subconjunctival triamcinolone acetonide injected prior to surgery in 15 eyes of patients considered to be at increased risk for postoperative scarring.5 All eyes were followed for six to 16 months with fourteen considered successfully controlled with an IOP of 12.4 ± 4.6 and only three of the 14 eyes required antiglaucoma medica- tions. Tham and colleagues reported on the intraoperative subconjunctival injection of triamcinolone acetonide using a 27-gauge needle in 11 patients. Results showed this method to be compatible with successful clinical outcomes.6 Table 1 Pre- and postoperative intraocular pressure in patients receiving retrobulbar triamcinolone acetonide at time of trabecu- lectomy IOP (n = 14) Mean and standard deviation (mm Hg) Preoperative IOP POD 1 IOP POD 7 IOP POD 30 IOP POD 90 IOP POD 180 IOP 26.43 ± 8.32 11.36 ± 3.67 9.86 ± 3.42 11.07 ± 2.40 10.42 ± 2.71 10.64 ± 1.82 Note: *Change in IOP from baseline was statistically signiﬁcant (p time points. Abbreviations: IOP, intraocular pressure; POD, postoperative day. 0.001) at all Clinical Ophthalmology 2009:3