R E V I E W Trabeculectomy with intraoperative retrobulbar triamcinolone acetonide Malik Y Kahook1 Larissa Camejo2 Robert J Noecker2 1Department of Ophthalmology, The Rocky Mountain Lions Eye Institute, University of Colorado Health Sciences Center, Aurora, CO, USA; 2UPMC Eye Center, Eye and Ear Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Correspondence: Malik Y Kahook Department of Ophthalmology, The Rocky Mountain Lions Eye Institute, PO BOX 6510 Mail Stop F-731, University of Colorado Health Sciences Center, Aurora, CO 80045, USA Tel +1 720 848 5029 Fax +1 720 848 5014 Email malik.kahook@gmail.com Abstract: Use of topical steroids is an important component of postoperative care after ﬁltration surgery. Efﬁcacy of postoperative medications is affected by patient adherence and physical limitations in the elderly population often prohibit proper dosing of ophthalmic drops. We describe a technique for the use of intraoperative retrobulbar triamcinolone acetonide in trabeculectomy surgery and report on postoperative outcomes. This technique appears safe and may be an attractive method of delivering a steroid depot at the time of trabeculectomy. Keywords: glaucoma, trabeculectomy, steroids Introduction Antiﬁbrotic medications augment the success of trabeculectomy procedures by decreas- ing ﬁbroblast proliferation and scar formation. In particular, Mitomycin C (MMC) acts as an alkylating agent and inhibits DNA-dependent RNA synthesis leading to decreased ﬁbroblast proliferation. MMC also has direct toxic effects on proliferating and nonproliferating cells causing cell apoptosis.1,2 Despite the improved success rate of antiﬁbrotic-assisted trabeculectomy, many cases fail due to persistent inﬂammation, scar formation, and eventual loss of intraocular pressure (IOP) control.3 The use of steroid drops postoperatively has been shown to increase the success rate of trabeculectomy surgery.4 Using drops requires a great deal of patient cooperation and instillation can be difﬁcult in those with already impaired vision and/or physical limitations. We performed consecutive trabeculectomy procedures with MMC and retrobulbar triamcinolone acetonide (RTA) in patients considered at high risk of failure due to previous unsuccessful glaucoma surgery. Methods This is a retrospective review of trabeculectomy procedures performed between July 2005 and January 2006 using intraoperative MMC and RTA. All surgeries were done using fornix based conjunctival incisions and MMC (0.2 mg/ml for 2 minutes). RTA (20 mg in 0.5 ml) was deposited in the retrobulbar space using a blunt cannula attached to a 5 ml syringe followed by conjunctival closure (Figures 1 and 2). Postoperative drop regimen consisted of prednisolone acetate 1%, fourth generation ﬂuoroquinolone, and atropine 1% each four times per day. Data collected included age, preoperative diagnosis, number of pre- and postoperative medications, pre- and postoperative IOP, and complication rates. Success was deﬁned as IOP 5 and 21 mm Hg without need for further medications or surgical intervention. Analysis of variance was used to compare statistical signiﬁcance between pre- and postoperative IOP values. Results Information was available from 14 consecutive cases, eight women and six men, under- going trabeculectomy with MMC and RTA. Mean age was 66.93 ± 14.51 years with Clinical Ophthalmology 2009:3 29–31 © 2009 Kahook et al, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 29