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Safety and efficacy of the use of prostaglandin analogues in the immediate postoperative period after uneventful phacoemulsification

Poster Details


First Author: A.Matsou GREECE

Co Author(s): E. Anastasopoulos   M. Dermenoudi   C. Keskini   A. Tzamalis   P. Brazitikos        

Abstract Details

Purpose:

Prostaglandin analogues have been implicated in the development of post-operative cystoid macular oedema after phacoemulsification complicated by posterior capsular rupture through disruption of the blood-aqueous barrier. It is therefore common practice to discontinue prostaglandin therapy and replace it with other IOP-lowering medications during the perioperative period, even in the absence of complications. Nevertheless, this theory is largely based on anecdotal reports and personal experience. The purpose of our study is to investigate the safety (development of cystoid macular oedema) and efficacy (adequate post-operative control of IOP) of prostaglandin analogues in the immediate post-operative period following uncomplicated phacoemulsification.

Setting:

2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece

Methods:

Thirty-six (36) subjects with a known diagnosis of glaucoma/ocular hypertension receiving prostaglandin analogue monotherapy who were due to undergo cataract surgery were prospectively enrolled over a 12-month period. Patients were randomized into two groups. The first group (GroupA, N = 18) continued prostaglandin treatment, while the second (GroupB, N = 18) discontinued treatment for 1 month after surgery. Patients with IOP rise of > 28 mmHg post-operatively were excluded and appropriate IOP-lowering treatment was administered. Best-corrected visual acuity, IOP and central macular thickness (CMT) were measured preoperatively, 1 week, 1 month and 3 months after surgery.

Results:

Baseline IOP did not show any statistically significant difference between study groups being measured 16.71±3.8 mmHg in GroupA and 17.05±4.1 mmHg in GroupB (p=0.79). Preoperative CMT was also found to be similar between groups (GroupA= 244.06±31.4μm; GroupB= 248,95±21.1μm, p=0.57). At 1 week and 1 month postoperatively average IOP in GroupA was 17.35±6.5 and 15.53±4.8 whilst in GroupB 17.95±3.6 and 16.2±4.6 respectively. CMT 1 month and 3 months postoperatively was 255.55±23.4μm and 263.76±23.6μm in GroupA, 258.31±33.2μm and 260.43±29.9μm in Group B respectively. No statistical significant differences in IOP or CME were noted between the study groups at any timepoint (p>0.05, ANOVA).

Conclusions:

Despite the theory that prostaglandin analogues may induce cystoid macular oedema after uncomplicated cataract surgery in a similar fashion as endogenous prostaglandin production, this is not confirmed by our results. It seems that prostaglandin analogues are safe to be continued in the peri-operative period in low risk patients. Stopping these agents is therefore not recommended in uncomplicated phacoemulsification, however cautious selection of patients at high risk of pseudophakic CMO (e.g. diabetic patients, complicated cataract surgery) is advised.

Financial Disclosure:

None

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