We read with interest the Iwao and associates’ article about steroid-induced glaucoma. The authors stated that the results after trabeculotomy were better than those after trabeculectomy in the steroid-induced glaucoma group. There are some points which need to be addressed.
First, 20 of 121 patients underwent sinusotomy combined with trabeculotomy. Kraznov introduced sinusotomy and reported a success rate of 83%. With respect to the different mechanism of sinusotomy in intraocular pressure reduction, the combined sinusotomy seems to have augmented the effect of trabeculotomy. Because a significant proportion of patients underwent a combined sinusotomy operation, performing a statistical analysis without these patients may change the results of the Kaplan-Meier curve.
Second, 10 patients in the trabeculotomy group received intravitreal steroids, whereas no patient in the trabeculectomy did. Although this difference may not be statistically significant, clinically, is important. It is clear that the steroids have wound-healing diminution effect. In those who received intravitreal steroids, the wound healing was attenuated, which could have induced a subconjunctival pathway and further aqueous drainage, especially if these patients had undergone a combined trabeculotomy and sinusotomy surgery.
Third, the steroid-induced intraocular pressure increase is usually short lived and reversible by discontinuance of therapy if the drug has not been used for more than 1 year. There are no data about the duration of steroid use in steroid-induced groups before and after surgery. In 53 patients, the steroid was stopped fewer than 3 months after operation, and it is not clear what percentage belonged to the trabeculotomy group. If most of the group underwent a trabeculotomy, this might have affected the results.