The use of NSAID eye drops does not seem to enhance SLT efficacy.

The use of NSAID eye drops does not seem to enhance SLT efficacy. Photo: Nate Lighthizer. Click image to enlarge.

Prescribing anti-inflammatory eye drops after selective laser trabeculoplasty (SLT) is a common practice. Apart from possibly reducing postoperative discomfort, it has been proposed that steroidal and non-steroidal (NSAID) eye drops may enhance SLT efficacy. Rather, a recent study found that IOP reduction was smaller in the NSAID group compared with the control group, even after correction for covariates in a multiple linear regression analysis.

The retrospective chart review included 192 eyes of 192 patients, half of whom received a course of NSAID eye drops after SLT. The researchers compared absolute and relative IOP reduction three to 12 weeks after SLT.

The mean absolute IOP reduction was 4.3mm Hg in the NSAID group and 5.4mm Hg in the control group. Relative IOP reduction was 17.5% and 21.8% in the NSAID and control groups, respectively. A multiple linear regression analysis confirmed NSAID treatment as a negative predictor of IOP reduction after adjustment for covariates. Survival analysis showed a longer median time to treatment escalation in the control group, though not statistically significant.

The researchers noted that surgeons might be more prone to prescribing NSAIDs after extensive or challenging SLT treatment. They added that less experienced and skilled surgeons tend to prescribe NSAIDs more often as well.

In some instances—e.g., with an increased risk of uveitis or macular or corneal edema—such treatment might be indicated for safety reasons. The researchers hope that future research will help guide treatment and shed light on whether pilocarpine or apraclonidine drops at the time of SLT have an impact on the outcome.

“No universal recommendation to prescribe or not to prescribe topical NSAID treatment after SLT can be made at this point,” the team concluded. “However, as a general rule, it might be more reasonable to abstain from a particular drug, if evidence for its benefit is lacking, than to prescribe it.”

Dahlgren T, Ayala M, Zetterberg M. The impact of topical NSAID treatment on selective laser trabeculoplasty efficacy. Acta Ophthalmol. October 18, 2022. [Epub ahead of print].