{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:09:06Z","timestamp":1792188546642,"version":"4.4.0"},"reference-count":43,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Health Research Endowment Fund","award":["HREF0218-2"],"award-info":[{"award-number":["HREF0218-2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: We aimed to determine if a 2-week pre-operative course of fluorometholone (FML) eyedrops in chronically medicated glaucoma patients reduces the levels of the pro-inflammatory cytokine Monocyte Chemoattractant Protein 1 (MCP-1) and improves early post-operative outcomes after trabeculectomy or phaco-trabeculectomy. Methods: We conducted a single-center, unmasked, prospective pilot interventional case series of 36 patients with glaucoma who received a 2-week course of FML eyedrops prior to undergoing trabeculectomy. A multiplex bead assay was used to quantify the presence of MCP-1 levels in tear samples before and after the use of FML eyedrops, and 307 eyes without treatment with topical FML served as historical controls. Clinical outcome measures of early post-operative outcomes included IOP and additional post-operative interventions (i.e., needling, glaucoma medications, and surgery) required to achieve the desired IOP at 6 months. Results: Out of 36 patients who received FML, 19 patients had a low MCP-1 level (&lt;250 pg\/mL\/mg) at baseline, which did not significantly change after using FML, and were excluded from analysis. Of the 17 remaining patients, propensity score-matched analysis was conducted to compare them with 17 patients who did not receive FML, matching for the variables of age, gender, ethnicity, diagnosis, longest glaucoma medication duration, and surgery type. Patients with FML treatment had lower odds of requiring any post-operative intervention (including needling, surgery, or IOP-lowering medications) (OR 0.22, CI 0.049\u20130.95, p = 0.042) compared to patients who did not have pre-operative FML treatment. Conclusions: In patients with higher levels of MCP-1 pre-operatively, the use of FML for 2 weeks pre-operatively improved their early post-operative outcomes following trabeculectomy or phaco-trabeculectomy.<\/jats:p>","DOI":"10.3390\/jcm14228057","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T16:46:22Z","timestamp":1763138782000},"page":"8057","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Study of Effects of Topical Fluorometholone on Tear MCP-1 in Eyes Undergoing Trabeculectomy: Effect on Early Trabeculectomy Outcomes in Asian Glaucoma Patients"],"prefix":"10.3390","volume":"14","author":[{"given":"Olivia Shimin","family":"Huang","sequence":"first","affiliation":[{"name":"Singapore National Eye Centre, Singapore 168751, Singapore"},{"name":"Singapore Eye Research Institute, Singapore 169856, Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"},{"name":"Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0474-6216","authenticated-orcid":false,"given":"Jackie Jia Lin","family":"Sim","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hla Myint","family":"Htoon","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore 169856, Singapore"},{"name":"Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabel Chee Yen","family":"Chew","sequence":"additional","affiliation":[{"name":"Singapore National Eye Centre, Singapore 168751, Singapore"},{"name":"Singapore Eye Research Institute, Singapore 169856, Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"},{"name":"Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel Shujuan","family":"Chong","sequence":"additional","affiliation":[{"name":"Singapore National Eye Centre, Singapore 168751, Singapore"},{"name":"Singapore Eye Research Institute, Singapore 169856, Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"},{"name":"Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5234-9621","authenticated-orcid":false,"given":"Rahat","family":"Husain","sequence":"additional","affiliation":[{"name":"Singapore National Eye Centre, Singapore 168751, Singapore"},{"name":"Singapore Eye Research Institute, Singapore 169856, Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"},{"name":"Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamira","family":"Perera","sequence":"additional","affiliation":[{"name":"Singapore National Eye Centre, Singapore 168751, Singapore"},{"name":"Singapore Eye Research Institute, Singapore 169856, Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"},{"name":"Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina T.","family":"Wong","sequence":"additional","affiliation":[{"name":"Singapore National Eye Centre, Singapore 168751, Singapore"},{"name":"Singapore Eye Research Institute, Singapore 169856, Singapore"},{"name":"Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"},{"name":"Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.preteyeres.2009.06.004","article-title":"The critical role of the conjunctiva in glaucoma filtration surgery","volume":"28","author":"Yu","year":"2009","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.ophtha.2011.09.043","article-title":"A twenty-year follow-up study of trabeculectomy: Risk factors and outcomes","volume":"119","author":"Landers","year":"2012","journal-title":"Ophthalmology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3432","DOI":"10.1167\/iovs.17-21480","article-title":"Inhibition of Monocyte Chemoattractant Protein 1 Prevents Conjunctival Fibrosis in an Experimental Model of Glaucoma Filtration Surgery","volume":"58","author":"Chong","year":"2017","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/S0161-6420(99)90116-1","article-title":"Ocular surface inflammatory changes induced by topical antiglaucoma drugs: Human and animal studies","volume":"106","author":"Baudouin","year":"1999","journal-title":"Ophthalmology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1001\/archopht.1994.01090230051020","article-title":"Adverse effects of topical antiglaucoma medication. I. The conjunctival cell profile","volume":"112","author":"Broadway","year":"1994","journal-title":"Arch. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1001\/archopht.1994.01090230060021","article-title":"Adverse effects of topical antiglaucoma medication. II. The outcome of filtration surgery","volume":"112","author":"Broadway","year":"1994","journal-title":"Arch. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/S0161-6420(92)32001-9","article-title":"Foreshortening of the inferior conjunctival fornix associated with chronic glaucoma medications","volume":"99","author":"Schwab","year":"1992","journal-title":"Ophthalmology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2353","DOI":"10.1016\/j.ophtha.2010.03.064","article-title":"Tear cytokine profile in medicated glaucoma patients: Effect of monocyte chemoattractant protein 1 on early posttrabeculectomy outcome","volume":"117","author":"Chong","year":"2010","journal-title":"Ophthalmology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1001\/archopht.1983.01040010795021","article-title":"Histologic characteristics of filtering blebs in glaucomatous eyes","volume":"101","author":"Addicks","year":"1983","journal-title":"Arch. Ophthalmol."},{"key":"ref_10","first-page":"84","article-title":"Clinico pathological correlation in eyes with failed fistulizing surgery","volume":"103","author":"Hitchings","year":"1983","journal-title":"Trans. Ophthalmol. Soc. UK"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/0039-6257(87)90091-9","article-title":"Wound healing in glaucoma filtering surgery","volume":"32","author":"Skuta","year":"1987","journal-title":"Surv. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1016\/j.ophtha.2009.11.038","article-title":"Preoperative nonsteroidal anti-inflammatory drug or steroid and outcomes after trabeculectomy: A randomized controlled trial","volume":"117","author":"Breusegem","year":"2010","journal-title":"Ophthalmology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"75","DOI":"10.17116\/oftalma2015131175-81","article-title":"Options for prolonging the hypotensive effect of trabeculectomy","volume":"131","author":"Petrov","year":"2015","journal-title":"Vestn. Oftalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.survophthal.2012.01.008","article-title":"Wound modulation after filtration surgery","volume":"57","author":"Seibold","year":"2012","journal-title":"Surv. Ophthalmol."},{"key":"ref_15","first-page":"857","article-title":"Improving patient outcomes following glaucoma surgery: State of the art and future perspectives","volume":"8","author":"Vandewalle","year":"2014","journal-title":"Clin. Ophthalmol."},{"key":"ref_16","first-page":"29","article-title":"Trabeculectomy with intraoperative retrobulbar triamcinolone acetonide","volume":"3","author":"Kahook","year":"2009","journal-title":"Clin. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1016\/S0161-6420(95)30797-X","article-title":"A ten-year follow-up on a prospective, randomized trial of postoperative corticosteroids after trabeculectomy","volume":"102","author":"Araujo","year":"1995","journal-title":"Ophthalmology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S0039-6257(98)00025-3","article-title":"Dysfunctional filtering blebs","volume":"43","author":"Katz","year":"1998","journal-title":"Surv. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1007\/s10792-020-01688-8","article-title":"National survey of intraoperative mitomycin C use during trabeculectomy surgery in the UK","volume":"41","author":"Khan","year":"2021","journal-title":"Int. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1111\/aos.13919","article-title":"Steroids and nonsteroidal anti-inflammatory drugs in the postoperative regime after trabeculectomy\u2014Which provides the better outcome? A systematic review and meta-analysis","volume":"97","author":"Almatlouh","year":"2019","journal-title":"Acta Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"519","DOI":"10.3109\/08820538.2014.986585","article-title":"A National Survey of Glaucoma Specialists on the Preoperative (Trabeculectomy) Management of the Ocular Surface","volume":"31","author":"Tailor","year":"2016","journal-title":"Semin. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1038\/sj.eye.6701477","article-title":"A review of trabeculectomy in East Asian people--the influence of race","volume":"19","author":"Husain","year":"2005","journal-title":"Eye"},{"key":"ref_23","first-page":"748","article-title":"Bleb needling outcomes for failed trabeculectomy blebs in Asian eyes: A 2-year follow up","volume":"8","author":"Tsai","year":"2015","journal-title":"Int. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/S0002-9394(01)01028-5","article-title":"The Advanced Glaucoma Intervention Study (AGIS): 9. Comparison of glaucoma outcomes in black and white patients within treatment groups","volume":"132","author":"Investigators","year":"2001","journal-title":"Am. J. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"271","DOI":"10.2147\/OPTH.S52055","article-title":"Critical analysis of the classification of glaucomas issued by the European Glaucoma Society in 2008","volume":"8","author":"Bordeianu","year":"2014","journal-title":"Clin. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1001\/archopht.1996.01100130258004","article-title":"Reversal of topical antiglaucoma medication effects on the conjunctiva","volume":"114","author":"Broadway","year":"1996","journal-title":"Arch. Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s00417-002-0581-9","article-title":"Efficacy of indomethacin 0.1% and fluorometholone 0.1% on conjunctival inflammation following chronic application of antiglaucomatous drugs","volume":"240","author":"Baudouin","year":"2002","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1089\/jir.2008.0027","article-title":"Monocyte chemoattractant protein-1 (MCP-1): An overview","volume":"29","author":"Deshmane","year":"2009","journal-title":"J. Interferon Cytokine Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"133","DOI":"10.2500\/108854101778148737","article-title":"MCP-1 and RANTES are mediators of acute and chronic inflammation","volume":"22","author":"Conti","year":"2001","journal-title":"Allergy Asthma Proc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"107598","DOI":"10.1016\/j.intimp.2021.107598","article-title":"MCP-1: Function, regulation, and involvement in disease","volume":"101","author":"Singh","year":"2021","journal-title":"Int. Immunopharmacol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1161\/ATVBAHA.108.162925","article-title":"Chemokines as mediators of neovascularization","volume":"28","author":"Keeley","year":"2008","journal-title":"Arter. Thromb. Vasc. Biol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1182\/blood.V96.1.34","article-title":"Human endothelial cells express CCR2 and respond to MCP-1: Direct role of MCP-1 in angiogenesis and tumor progression","volume":"96","author":"Salcedo","year":"2000","journal-title":"Blood"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"203","DOI":"10.3349\/ymj.2014.55.1.203","article-title":"Inflammatory cytokine and osmolarity changes in the tears of dry eye patients treated with topical 1% methylprednisolone","volume":"55","author":"Lee","year":"2014","journal-title":"Yonsei Med. J."},{"key":"ref_34","first-page":"2693","article-title":"Effect of steroids and nonsteroidal antiinflammatory agents on human ocular fibroblast","volume":"33","author":"Nguyen","year":"1992","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e377","DOI":"10.1097\/IJG.0000000000000377","article-title":"In Vivo Confocal Microscopy and Biomicroscopy of Filtering Blebs After Trabeculectomy","volume":"25","author":"Caglar","year":"2016","journal-title":"J. Glaucoma"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1016\/j.ophtha.2005.05.021","article-title":"In vivo confocal microscopy study of blebs after filtering surgery","volume":"112","author":"Labbe","year":"2005","journal-title":"Ophthalmology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1001\/archopht.124.8.1095","article-title":"In vivo confocal microscopy of filtering blebs after trabeculectomy","volume":"124","author":"Messmer","year":"2006","journal-title":"Arch. Ophthalmol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1001\/archopht.121.6.825","article-title":"High expression of chemokines Gro-alpha (CXCL-1), IL-8 (CXCL-8), and MCP-1 (CCL-2) in inflamed human corneas in vivo","volume":"121","author":"Spandau","year":"2003","journal-title":"Arch. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/j.ajo.2014.08.015","article-title":"Effects of topical loteprednol etabonate on tear cytokines and clinical outcomes in moderate and severe meibomian gland dysfunction: Randomized clinical trial","volume":"158","author":"Lee","year":"2014","journal-title":"Am. J. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"781683","DOI":"10.1155\/2014\/781683","article-title":"Aging: A predisposition to dry eyes","volume":"2014","author":"Sharma","year":"2014","journal-title":"J. Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1001\/archopht.1986.01050180072032","article-title":"The effect of preoperative subconjunctival triamcinolone administration on glaucoma filtration. I. Trabeculectomy following subconjunctival triamcinolone","volume":"104","author":"Giangiacomo","year":"1986","journal-title":"Arch. Ophthalmol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Pilat, J., Przekora, A., Wrobel-Dudzinska, D., Kazimierczak, P., Zarnowski, T., and Kosior-Jarecka, E. (2023). Analysis of the impact of different schemes of preparation to trabeculectomy on the healing markers on the Tenon fibroblasts cultures. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-43246-z"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Jonsdottir, I.H., Hagg, D.A., Glise, K., and Ekman, R. (2009). Monocyte chemotactic protein-1 (MCP-1) and growth factors called into question as markers of prolonged psychosocial stress. PLoS ONE, 4.","DOI":"10.1371\/journal.pone.0007659"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8057\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T17:01:47Z","timestamp":1763139707000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8057"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,13]]},"references-count":43,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14228057"],"URL":"https:\/\/doi.org\/10.3390\/jcm14228057","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,13]]}}}