Preoperative fluorometholone in glaucoma surgery: 1 Year clinical and anatomical outcomes with in vivo confocal microscopy (IVCM)

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Aims/Purpose: To report preliminary data on the preoperative application of topical Fluorometholone in patients requiring glaucoma surgery due to primary open‐angle glaucoma (POAG), evaluating clinical and anatomical outcomes with in vivo confocal microscopy (IVCM) at 1 year follow‐up. Methods: We conducted a prospective study involving 54 eyes with POAG requiring glaucoma surgery: Trabeculectomy or Minimally Invasive Bleb Surgery (MIBS) (XEN® and PreserFlo®). The sample was randomized: the treatment group (25 eyes) received Fluorometholone 1mg/ml QID for 1 month pre‐surgery, while the control group (29 eyes) did not. IVCM of the conjunctiva was performed at baseline, after 1 month of treatment, and 1 year post‐surgery. Preoperative parameters included goblet cell density (GCD) and dendritic cell density (DCD) as inflammatory markers, while postoperative parameters were density and mean area of intraepithelial cysts (MMD and MMA) as indices of bleb function. Pre and post‐surgery stromal meshwork reflectivity (SMR) served as an indirect marker of stromal collagen. Results: Preoperative Fluorometholone led to significantly decreased in DCD (p < 0.001) compared to baseline and in DCD (p < 0.001) and SMR (p = 0.014) compared to the control group. At 1 year, there were no significant differences between the two groups in mean IOP, medications, needling procedures, and failure rates. IVCM analysis showed increased MMD in the treatment group compared to the control group (p = 0.028). In the separate analysis, the MIBS treatment subgroup group had lower IOP (p = 0.046) and less medication use (p = 0.032), but this was not observed in the trabeculectomy treatment subgroup. MMD increased in both the MIBS (p = 0.037) and trabeculectomy (p = 0.024) treatment subgroups. Conclusions: Preoperative Fluorometholone reduced ocular inflammation, improving bleb function at 1 year as detected by IVCM. However, its impact on overall bleb functionality remains unclear, with a clinically detectable improvement only in the MIBS group. Larger studies with longer follow‐up are necessary to fully understand the implications of preoperative Fluorometholone on long‐term surgical outcomes across different types of glaucoma surgeries.

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