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Analysis of cases of macular edema induced by prostaglandin analogues in patients operated because of primary glaucoma

Poster Details

First Author: A.Egorova RUSSIA

Co Author(s):    A. Vasilyev   A. Khudyakov           

Abstract Details



Purpose:

The analysis of cases of macular edema (ME), induced by prostaglandin analogues (PA) usage in patients operated because of primary glaucoma. Macular edema is considered to be one of serious early postoperative complications [Henderson B.A., et al., 2008; Schumer R.A., Camras C.B., Mandahl A.K.; 2000]. In spite of the fact that majority of publications devoted to this complication are related to cataract surgery, ME development can occur after glaucoma surgery.

Setting:

Khabarovsk branch of the State Institution Eye Microsurgery Complex named after S.N. Fyodorov.

Methods:

We have performed analysis of 4 cases of ME development in 4 patients who underwent nonpenetrative deep sclerectomy because of primary noncompensated glaucoma of I-II stage. Patients' age varied from 69 to 73 years (71±1,1in the average). Preoperative and repeated examinations enclosed vision acuity checking, Maklakov's tonometry, biomicroscopy, direct and indirect ophthalmoscopy. Besides, all patients were examined by optical coherent tomography (OCT) on Stratus OCT 3000' device (Carl Zeiss,Germany) using 'Macular thickness map' analysis report. Preoperative IOP varied from 29-32 mm Hg on hypotensive regimen (0,004% travatan ophthalmic solution), vision acuity made 0.7-0.8. All patients had initial senile cataract, none of them had pathology of retina in macular area. Nonpenetrative deep sclerectomy according to Fyodorov and Kozlov technique (1984) was performed in all cases.

Results:

All operations passed uneventfully, postoperative period was also unremarkable. The IOP normalization (14-16 mm Hg.) was achieved in all patients at the discharge from the clinic (2nd-3st postoperative day) without any additional hypotensive therapy. Postoperative BCVA corresponded to preoperative and made 0.7-0.9. All patients were discharged for postoperative treatment in local clinics. All patients were prescribed travatan and xalatan ophthalmic solutions for instillation into operated eye due to IOP increase up to 24-26 mm Hg, and they have noticed lowering of vision acuity (down to 0.2-0.7 with correction) in terms of 2-8 weeks after beginning of PA instillations. BCVA was 0.2-0.35, IOP varied from 16 to 19 mm Hg on hypotensive regimen at addressing to our clinic. Biomicroscopy revealed mild injection of conjunctiva vessels in the area of surgical intervention, the signs of ME - pathological glare, mild folds of retina, weakening of foveal reflex were diagnosed using ophthalmoscopy. ME was proved in all 4 cases using OCT device, the increase of retinal thickness from 345 to 460 mcm in the central macular sector, retinal volume in macula was enlarged up to 7,6-7,8 mm3 were found, correspondingly.

Conclusions:

It is not expedient to use prostaglandin analogues in early postoperative period after glaucoma surgery because of high risk of macular edema development. FINANCIAL INTEREST: NONE

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