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Anastasopoulos E, Koronis S, Matsou A, Dermenoudi M, Ziakas N, Tzamalis A. Safety and Efficacy of Prostaglandin Analogues in the Immediate Postoperative Period after Uneventful Phacoemulsification. Vision (Basel) 2023; 7:45. [PMID: 37368818 DOI: 10.3390/vision7020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Prostaglandin analogues (PGAs) have been associated with the development of pseudophakic macular edema (PME) in complicated cataract cases, but evidence on their effects in uncomplicated phacoemulsification remains controversial. This two-arm, prospective, randomised study included patients with glaucoma or ocular hypertension under PGA monotherapy who were scheduled for cataract surgery. The first group continued PGA use (PGA-on), while the second discontinued PGAs for the first postoperative month and reinitiated use afterwards (PGA-off). Topical non-steroidal anti-inflammatory drugs (NSAIDs) were routinely administered to all patients during the first postoperative month. The patients were followed up for three months and the primary outcome was PME development. Secondary outcomes were corrected distance visual acuity (CDVA), central and average macular thickness (CMT and AMT), and intraocular pressure (IOP). The analysis included 22 eyes in the PGA-on group and 33 eyes in the PGA-off group. No patient developed PME. CDVA was not significantly different between the two groups (p = 0.83). CMT and AMT showed a small but statistically significant increase until the end of follow-up (p < 0.001). Mean IOP values had no significant differences between the groups at each visit (p > 0.05). At the end of follow-up, the IOP values were significantly lower than baseline in both groups (p < 0.001). In conclusion, PGA administration with concomitant topical NSAIDs appears to be a safe practice in the early postoperative period of uncomplicated phacoemulsification.
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Affiliation(s)
| | - Spyridon Koronis
- Department of Ophthalmology, General Hospital Papageorgiou, 56429 Thessaloniki, Greece
| | - Artemis Matsou
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK
| | - Maria Dermenoudi
- Department of Ophthalmology, General Hospital Papageorgiou, 56429 Thessaloniki, Greece
| | - Nikolaos Ziakas
- Department of Ophthalmology, General Hospital Papageorgiou, 56429 Thessaloniki, Greece
| | - Argyrios Tzamalis
- Department of Ophthalmology, General Hospital Papageorgiou, 56429 Thessaloniki, Greece
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Lee SH, Lee WJ, Kim KW, Jeong JH, Park IK, Chun YS. Influence of 0.002% Omidenepag Isopropyl on Intraocular Pressure and the Cornea in Normal Tension Glaucoma. J Glaucoma 2023; 32:245-251. [PMID: 36729067 DOI: 10.1097/ijg.0000000000002167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/10/2022] [Indexed: 02/03/2023]
Abstract
PRCIS Although Omidenepag isopropyl drops elicited stable intraocular pressure reductions in NTG patients, transient changes in refraction and corneal endothelial cells, significant increase of central corneal thickness, and corneal erosion should be considered. PURPOSE To analyze the efficacy and safety of 0.002% omidenepag Isopropyl (OMDI) eye drops in patients with normal tension glaucoma (NTG). METHODS Medical records for 62 eyes treated with OMDI for ≥6 months were analyzed. Intraocular pressure (IOP), refraction, keratometry, central corneal thickness (CCT), endothelial cell count, coefficient of variation of endothelial cell area (CV), corneal erosion, and central retinal thickness were compared at baseline and 1, 3, and 6 months. RESULTS IOP significantly decreased from 13.4±3.8 to 11.9±3.0, 11.7±2.9, and 12.2±3.3 mm Hg at each follow-up ( P <0.001). Endothelial cell count did not change, but CV transiently increased from 12.6 to 17.0 at 1 month, CCT increased from 531.5 to 538.4 μm, myopia changed from -1.5 to -1.9 D, and keratometry changed from 44.5 to 44.7 D. CV, myopia, and keratometry recovered to baseline at 6 months; however, CCT remained high. Significant corneal erosion was observed at 6 months. Central retinal thickness changes were not observed. There were improvements in prostaglandin-associated skin pigmentation (86.7%), eyelash elongation (40.0%), and deepening of the upper eyelid sulcus and ptosis (~30%) at 3 months after exchange to OMDI. Adverse reactions were corneal erosion (27.4%), corneal thickening (21.0%), conjunctival hyperemia (11.3%), photophobia (5.7%), blurred vision (5.7%), and anterior chamber cells (4.8%). CONCLUSIONS OMDI eye drops elicited significant and stable IOP reductions after 6 months in NTG patients with low IOP. However, transient myopic and corneal endothelial cell changes, development of corneal thickening, and corneal erosion should be considered when using OMDI.
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Affiliation(s)
- Seung Hyeun Lee
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine
| | - Won Jun Lee
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine
| | - Kyoung Woo Kim
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine
| | - Jae Hoon Jeong
- Departement of Ophthalmology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong City, Gyeonggido
| | - In Ki Park
- Department of Ophthalmology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Yeoun Sook Chun
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine
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Özyol E, Özyol P, Günel-Karadeniz P. The Use of Prostaglandin Analogues and Cystoid Macular Edema after Uneventful Cataract Surgery: A Systematic Review and Meta-Analysis. Semin Ophthalmol 2023:1-8. [PMID: 36703301 DOI: 10.1080/08820538.2023.2170716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate whether using prostaglandin analogues (PGAs) perioperatively is associated with an increased rate of the development of clinical or subclinical cystoid macular edema (CME) after uneventful cataract surgery. METHODS The PubMed, Scopus, and ScienceDirect databases were searched to June 2022 for this systematic review and meta-analysis. Two authors independently screened search results. Random-effects meta-analyses were performed to calculate the overall incidence rate and odds ratio (OR). Quality of studies was assessed using the modified Newcastle-Ottawa scale. The incidences of CME for continued vs discontinued use of PGAs perioperatively, continued use of PGAs, discontinued use of PGAs, and PGA users vs non-PGA antiglaucomatous users were main outcomes. RESULTS Out of 544-articles, 9 studies that met the inclusion criteria were analyzed. The continued use of PGAs was not associated with an increased risk of the development of subclinical macular edema compared with discontinued use (OR = 1.32 [95% Confidence Interval (CI) = 0.49-3.51], p = .582). The overall incidence of CME was 34% (95% CI = 0.17-0.52) for continued use of PGAs and 7% (95% CI = 0.02-0.13) for discontinued use of PGAs. Using PGAs did not increase the risk of CME's development compared with non-PGA antiglaucomatous usage (OR = 2.29 [95% CI = 0.84-6.23], p = .103). CONCLUSIONS Discontinuing treatment with PGAs during the perioperative period in eyes without any known risk factors for CME has no clinically significant effect on reducing the development of postoperative CME based on the existing studies. Further, well-designed randomized controlled trials need to be performed.
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Affiliation(s)
- Erhan Özyol
- SANKO University Faculty of Medicine, Ophthalmology Department, Gaziantep, Turkey
| | - Pelin Özyol
- SANKO University Faculty of Medicine, Ophthalmology Department, Gaziantep, Turkey
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Li SS, Wang HH, Wang YL, Zhang DW, Chen X. Comparison of the efficacy and safety of non-steroidal anti-inflammatory drugs and corticosteroid drugs for prevention of cystoid macular edema after cataract surgery. Int Ophthalmol 2023; 43:271-284. [PMID: 36065039 DOI: 10.1007/s10792-022-02426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 07/04/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION To compare the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAID), corticosteroid (CS), and a combination of both drugs to prevent cystoid macular edema (CME) after cataract surgery. METHODS We searched Pubmed, Cochrane Library, and Embase electronic databases to assess the relevant randomized controlled trials (RCTs) up to 28 April 2021. Network meta-analysis was registered on PROSPERO (CRD42020182520). RESULTS Twenty-four RCTs were included in this review. The NSAID and combination of both drugs were significantly reduced the risk of developing CME than CS alone in non-diabetics and mix populations. In the ranking profiles, the combination therapy showed a significant advantage over the single drugs and was less likely to develop CME. Diclofenac was the most likely to reduce the odds of developing CME compared with bromfenac and nepafenac. Dexamethasone was the most likely to reduce the odds of developing CME compared with betamethasone and fluorometholone. CONCLUSION NSAID combination with CS has significantly reduced the risk of developing CME postoperatively than the single drug. Diclofenac was superior to bromfenac and nepafenac in preventing CME. Dexamethasone was superior to betamethasone and fluorometholone in preventing CME.
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Affiliation(s)
- Shan-Shan Li
- Department of Ophthalmology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
| | - Hui-Hui Wang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yan-Ling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Da-Wei Zhang
- Department of Ophthalmology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xi Chen
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Niyadurupola N, Brodie J, Patel T, Chan J, Rahman MM, Svasti-Salee CR, Ching J, Misra A, Eke T, Broadway DC. Topical prostaglandin analogue use and cystoid macular oedema following uneventful cataract surgery: a randomised control trial. Br J Ophthalmol 2022; 106:1662-1666. [PMID: 34045222 DOI: 10.1136/bjophthalmol-2021-319149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/16/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS The association between the development of cystoid macular oedema (CMO) following uneventful cataract surgery and prostaglandin analogue (PGA) therapy has not been fully determined. The study aim was to investigate whether discontinuation of PGA therapy following uneventful cataract surgery affected the incidence of postoperative CMO. METHODS A prospective randomised controlled trial of 62 eyes of 62 participants with ocular hypertension (OH) or primary open angle glaucoma (POAG) treated with PGAs prior to cataract surgery. Participants were randomised to continue with PGA therapy after cataract surgery (CPGA) (n=31) or to discontinue PGA therapy (n=31). The primary outcome measure was the development of CMO at 1-month postoperatively, determined by a masked observer assessment of optical coherence tomography scans. The secondary outcome measure was change from baseline intraocular pressure (IOP). RESULTS The incidence of CMO was identical in both groups at 12.9% (4 of 31 eyes) at the 1-month postoperative visit (OR 1.000; 95% CI 0.227 to 4.415). At 1-month postoperatively, the IOP was significantly lower in the CPGA group compared with baseline IOP. CONCLUSION Continuation of PGA therapy following uneventful cataract surgery in eyes with normal macular morphology did not increase the incidence of CMO. Continuation of PGA therapy significantly reduced IOP at 1-month postoperatively suggesting that, when indicated, it might be beneficial to continue PGA therapy in patients with POAG or OH after uneventful cataract surgery in the absence of other risk factors for developing CMO.
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Affiliation(s)
- Nuwan Niyadurupola
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - James Brodie
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Tejal Patel
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Jason Chan
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Mohammad M Rahman
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Carl R Svasti-Salee
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Jared Ching
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Aseema Misra
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Tom Eke
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - David C Broadway
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
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Brooks HL, Ozkardes C. Intentional use of topical latanoprost with resulting macular edema to help in the closure of a failed, chronic, macular hole. Am J Ophthalmol Case Rep 2022; 27:101603. [PMID: 35722056 PMCID: PMC9198321 DOI: 10.1016/j.ajoc.2022.101603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a case where the induction of macular edema with topical latanoprost coupled with in-office gas injection effectively sealed a persistent, chronic, macular hole. Observations A 70-year-old, pseudophakic, patient presented with a stage three, chronic, macular hole (MH) and vision reduced to 20/200. The symptoms had been present for 18 months. Patient had surgery with pars plana vitrectomy (PPV), complete internal limiting membrane (ILM) peel to the arcades, 30% SF6 gas, and excellent face down positioning for five days. Two weeks after surgery the macular hole failed to close, and the edges of the hole were blunted with very little retinal edema and vision reduced to 20/400. The patient did not want to go back to the operating room. After informed consent, the patient was started on topical latanoprost 0.005% on the operative eye twice a day for six weeks. After latanoprost induction of cystoid macular edema (CME), the patient had 0.7 cc of pure C3F8 injected into the vitreous cavity in the office and was instructed to be face down for five days. Two weeks later the macular hole was closed with vision of 20/80. Last corrected vision eight months later was 20/50. Conclusions and Importance The findings in this case suggest that induction of CME facilitated the closure of a chronic, persistent, macular hole with a simple gas injection in the office and face down positioning for five days.
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Affiliation(s)
- H Logan Brooks
- Southern Vitreoretinal Associates, 2439 Care Rd, Tallahassee, FL, 32308, USA
- Corresponding author. 2439 Care Rd, Tallahassee, FL, 32308, USA.
| | - Cuneyt Ozkardes
- Florida State University College of Medicine, 1115 West Call St, Tallahassee, FL, 32306, USA
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Lan YW, Lin WC, Hsieh JW, Tsai S. Latanoprost-associated cystoid macular edema in a patient with phakic eyes. Taiwan J Ophthalmol 2022. [PMID: 37484608 PMCID: PMC10361437 DOI: 10.4103/tjo.tjo_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Here, we report a case of bilateral cystoid macular edema (CME) in a woman with phakic eyes after 22 years of latanoprost use. Optical coherence tomography revealed multiple intraretinal cysts, and fluorescein angiography revealed characteristic petaloid dye leakage from the perifoveal capillaries. A cause-effect relationship was suspected when CME resolved after switching from latanoprost to dorzolamide, as confirmed by positive rechallenge and dechallenge tests. Since prostaglandin analog-induced CME has only been reported in patients with pseudophakic, aphakic, or phakic eyes with retinal conditions predisposing to macular edema, this seems to be the first reported case of latanoprost-induced CME in a patient with phakic eyes without retinal risk factors.
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Azimpour S, Emami Alagha H, Faghihi H, Rajaei SM, Shokoohimand A. Effects of 0.0015% preservative-free tafluprost on the equine eye. Vet Ophthalmol 2021; 25:173-179. [PMID: 34806805 DOI: 10.1111/vop.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 10/28/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effects and potential side effects of topical preservative-free (PF) tafluprost 0.0015% in ophthalmologically normal horses. ANIMALS Five adult grade horses. PROCEDURES One of the eyes of each horse was randomly chosen as the "treatment" eye, and consequently, the contralateral eye served as the "control." A single dose of PF tafluprost 0.0015% (0.2 mL) was instilled in the treated eye of each horse. Intraocular pressure (IOP), Schirmer's tear test (STT) levels of each eye, and an ophthalmic examination were performed at T0 (baseline), T30, T120, T24 h, and T48 h. RESULTS The mean IOP values of the treated eyes at baseline (T0), T30, T120, T24 h, and T48 h were 25.4 ± 4.8 mmHg, 21.2 ± 1.92 mmHg, 15.20 ± 2.48 mmHg, 18.40 ± 1.51 mmHg, and 24.60 ± 1.94 mmHg, respectively. Significant differences were observed between the mean baseline IOP level and the T120 and T24 h time points (p = .001 and p = .009). The mean STT levels at each time point showed insignificant fluctuations during the study (p = .140). Adverse effects such as chemosis and episcleral injection were observed 30 min after the instillation of tafluprost 0.0015% (T30). Blepharospasm and conjunctival hyperemia were observed 120 min (T120) after the administration of the medication. CONCLUSION AND CLINICAL RELEVANCE Tafluprost 0.0015% showed potential in reducing IOP, but due to its local side effects, it is not a good candidate for management of glaucoma in horses. Tafluprost did not notably affect STT.
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Affiliation(s)
- Saeed Azimpour
- Department of Veterinary Medicine, Babol Branch, Islamic Azad University, Babol, Iran
| | - Hannah Emami Alagha
- Department of Clinical Sciences, College of Veterinary Medicine, Islamic Azad University, Karaj Branch, Alborz, Iran
| | - Houman Faghihi
- Ophthalmology Section, Negah Veterinary Centre, Tehran, Iran.,Department of Clinical Sciences, Faculty of Veterinary Specialized Sciences, Islamic Azad University, Science and Research Branch, Tehran, Iran
| | - Seyed Mehdi Rajaei
- Department of Clinical Sciences, College of Veterinary Medicine, Islamic Azad University, Karaj Branch, Alborz, Iran.,Ophthalmology Section, Negah Veterinary Centre, Tehran, Iran
| | - Armin Shokoohimand
- Ophthalmology Section, Negah Veterinary Centre, Tehran, Iran.,Department of Clinical Sciences, Faculty of Veterinary Specialized Sciences, Islamic Azad University, Science and Research Branch, Tehran, Iran
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Retinal thickness and incidence of pseudophakic cystoid macular edema in patients with primary open-angle glaucoma, receiving prostaglandin analogues. OPHTHALMOLOGY JOURNAL 2021. [DOI: 10.17816/ov64116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Cataract is often associated with primary glaucoma. Prostaglandin analogues use is considered to be a risk factor for pseudophakic cystoid macular edema.
Purpose. To evaluate the effect of prostaglandin analogues and non-steroidal anti-inflammatory drops on the central retinal thickness and the incidence of pseudophakic cystoid macular edema after phacoemulsification with intraocular lens implantation in patients with primary open-angle glaucoma.
Materials and methods. 91 patients were enrolled in the study. 22 patients (22 eyes) were included in the first main group and 22 patients (22 eyes) were included in the second main groups. All patients in main groups had glaucoma and used prostaglandin analogues. 47 patients (57 eyes) without glaucoma were included in the control group. All patients were treated with topical antibiotics and steroids after phacoemulsification. Patients in the main second and in the control groups also received non-steroidal anti-inflammatory drops. The retinal thickness was measured by optical coherence tomography 2 weeks, 2 months and 6 months after the operation.
Results. After the operation, the foveal thickness in patients of the first and the second groups was increased, but it had returned to the preoperative level after 6 months in the first group and after 2 months in the second group. The retinal thickness in the fovea in the control group decreased after the surgery and it has been increasing gradually but did not achieve the preoperative value.
Conclusion. Prostaglandin analogues use after phacoemulsification with intraocular lens implantation does not affect the incidence of pseudophakic cystoid macular edema. Prescribing non-steroidal anti-inflammatory drops after the surgery helps to achieve faster normalization of the central retinal thickness.
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Aihara M, Lu F, Kawata H, Iwata A, Odani-Kawabata N. Twelve-month efficacy and safety of omidenepag isopropyl, a selective EP2 agonist, in open-angle glaucoma and ocular hypertension: the RENGE study. Jpn J Ophthalmol 2021; 65:810-819. [PMID: 34495425 DOI: 10.1007/s10384-021-00868-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/28/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the long-term safety and efficacy of omidenepag isopropyl (OMDI) 0.002% (a first-in-class, selective, non-prostaglandin, prostanoid EP2 receptor agonist), alone or administered concomitantly with timolol 0.5%, in patients with open-angle glaucoma (OAG, including normal-tension and exfoliation glaucoma) or ocular hypertension (OHT). STUDY DESIGN Open-label, multicenter, Phase 3 study (NCT02822729). METHODS Patients aged ≥ 20 years, with OAG or OHT, and a baseline diurnal intraocular pressure (IOP) ≥ 16- < 22 mmHg (Group 1) or ≥ 22- ≤ 34 mmHg (Groups 2 and 3) were enrolled. All patients (N = 125) received OMDI 0.002% once daily. Group 3 also received timolol 0.5% twice daily. IOP was measured at baseline and at Weeks 2, 4, 8, 12, 26, 40, and 52. RESULTS Significant reductions in mean diurnal IOP from baseline occurred at every visit (P < 0.0001). Mean ± SE diurnal IOP reduction at Week 52 was -3.7 ± 0.3 mmHg (Group 1), -5.6 ± 0.5 mmHg (Group 2), and -8.4 ± 0.6 mmHg (Group 3). Most adverse events (AEs) were mild, and no serious treatment-related AEs were reported. Conjunctival hyperemia (incidence: monotherapy [Groups 1 and 2], 18.8%; concomitant [Group 3], 45.0%) and macular edema (ME)/cystoid macular edema (CME) (incidence: monotherapy, 11.8%; concomitant, 15.0%) occurred most frequently. All treatment-related ME/CME cases occurred in pseudophakic eyes and responded to standard-of-care treatment and study drug discontinuation. CONCLUSIONS In this study, OMDI 0.002%, alone or administered concomitantly with timolol 0.5%, resulted in sustained IOP reduction over 52 weeks in patients with OAG or OHT. Concomitant treatment resulted in increased efficacy and increased incidence of conjunctival hyperemia.
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Affiliation(s)
| | - Fenghe Lu
- Santen Inc., 6401 Hollis Street, Suite 125, Emeryville, CA, 94608, USA.
| | | | | | - Noriko Odani-Kawabata
- Santen Inc., 6401 Hollis Street, Suite 125, Emeryville, CA, 94608, USA.,Santen Pharmaceutical Co., Ltd., Osaka, Japan
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Mehta A, Lewis A. Multimodal etiology of drug induced angle closure with topical glaucoma therapy. Am J Ophthalmol Case Rep 2021; 23:101152. [PMID: 34307961 PMCID: PMC8258634 DOI: 10.1016/j.ajoc.2021.101152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 04/09/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We present a case of acute onset of bilateral choroidal effusions leading to angle closure glaucoma attributed to multiple mechanism of actions causing ciliary body and aqueous flow disruption in the setting of topical glaucoma therapy with latanoprost, brimonidine 0.2%, and Brinzolamide 0.1%. OBSERVATION The patient presented with ocular hypertension in the setting of bilateral choroidal effusions, leading to angle closure without pupillary block. After cessation of the glaucoma drops and starting steroids and cycloplegics, the patient's symptoms resolved. CONCLUSIONS AND IMPORTANCE This case report highlights the various physiological mechanisms of action that can induce angle closure glaucoma from commonly used topical medications for glaucoma treatment. Thus, a keen awareness is warranted of this idiosyncratic reaction in order to avoid morbidity and long term vision loss.
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Affiliation(s)
- Aditya Mehta
- William Beaumont Army Medical Center, El Paso, TX, USA
| | - Andrew Lewis
- Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
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Effects of Topical Prostaglandin Analog on Macular Thickness Following Cataract Surgery with Postoperative Topical Bromfenac Treatment. J Clin Med 2020; 9:jcm9092883. [PMID: 32906606 PMCID: PMC7564268 DOI: 10.3390/jcm9092883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose: To evaluate changes in macular thickness in patients continuing prostaglandin analog (PGA) treatment during the perioperative period involving bromfenac treatment. Methods: Patients with glaucoma who were using a topical PGA were randomly assigned to two groups in this randomized controlled trial: PGA continuing study group and PGA discontinued glaucoma control group. Patients without ocular diseases other than cataract were enrolled into the non-glaucomatous group. After the cataract surgery, the patients used bromfenac twice per day for 4 weeks. Optical coherence tomography was performed in all patients preoperatively and at 1 month postoperatively. Changes in macular thickness were compared among the three groups. Results: There were 32 eyes in the study group, 33 eyes in the glaucoma control group, and 58 eyes in the non-glaucomatous group. We found statistically significant postoperative changes in central macular thickness in all groups (4.30 ± 8.01 μm in the PGA continuing group, 9.20 ± 13.88 μm in the PGA discontinued group, and 7.06 ± 7.02 μm in the non-glaucomatous group, all p < 0.008), but no significant difference among the three groups (p = 0.161). Cystoid macular edema occurred in only one patient in the non-glaucomatous group (p = 0.568). Conclusions: Continuous use of PGAs during the perioperative period was not significantly associated with increased macular thickness after uncomplicated cataract surgery. In the absence of other risk factors (e.g., capsular rupture, uveitis, or diabetic retinopathy), discontinuing PGAs for the prevention of macular edema after cataract surgery with postoperative bromfenac treatment is unnecessary in patients with glaucoma.
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Holló G, Aung T, Cantor LB, Aihara M. Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: Mechanism, diagnosis, and management. Surv Ophthalmol 2020; 65:496-512. [PMID: 32092363 DOI: 10.1016/j.survophthal.2020.02.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 12/23/2022]
Abstract
Cystoid macular edema (CME) is a form of macular retina thickening that is characterized by the appearance of cystic fluid-filled intraretinal spaces. It has classically been diagnosed upon investigation after a decrease in visual acuity; however, improvements in imaging technology make it possible to noninvasively detect CME even before a clinically significant decrease in central vision. Risk factors for the development of CME include diabetic retinopathy, retinal vein occlusion, uveitis, and cataract surgery. It has been proposed that eyes with elevated intraocular pressure after cataract surgery, including those treated with prostaglandin analog eye drops, may be at higher risk for the development of CME. We summarize the current knowledge of the molecular mechanisms underlying CME, the potential role of ocular surgery and topical glaucoma medication in increasing the risk of CME, the newly developed imaging methods for diagnosing CME, and the clinical management of CME.
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Affiliation(s)
- Gábor Holló
- Glaucoma Unit, Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
| | - Tin Aung
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Opthalmology, National University of Singapore, Singapore
| | - Louis B Cantor
- Department of Opthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Makoto Aihara
- Department of Opthalmology, University of Tokyo, Tokyo, Japan
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Ilveskoski L, Taipale C, Tuuminen R. Anti-inflammatory Medication of Cataract Surgery in Pseudoexfoliation Syndrome - NSAID Is Needed. Curr Eye Res 2019; 45:814-819. [PMID: 31801388 DOI: 10.1080/02713683.2019.1701686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND To optimize the anti-inflammatory treatment of cataract surgery in pseudoexfoliation syndrome (PXF) eyes. METHODS A prospective randomized double-masked trial. Sixty eyes of 60 patients with PXF undergoing routine cataract surgery were randomized for potent topical postoperative anti-inflammatory medication either with prednisolone acetate (10mg/ml), nepafenac (1mg/ml) or their combination. Clinical outcome parameters were recorded at 28 days and 3 months. Recovery from surgery was recorded by a structured home questionnaire. RESULTS Patient age and gender distribution, and all baseline ophthalmic and surgical parameters were comparable between the study groups. At 28 days, change in central subfield macular thickness was +11.4 ± 11.9 µm in prednisolone acetate group compared to +1.7 ± 16.8 µm in nepafenac (P = .017), and -0.3 ± 8.7 µm in combination therapy (P = .010) groups. At 3 months, the values were +11.8 ± 18.1 µm, +1.8 ± 17.5 µm (P = .055), and -1.3 ± 6.4 µm (P = .055), respectively. Pseudophakic cystoid macular edema (PCME) was reported in two eyes, both with prednisolone acetate monotherapy. After surgery, conjunctival injection lasted 6.5 ± 5.0 days and irritation of the eye 9.5 ± 8.5 days in prednisolone acetate group compared with nepafenac (2.6 ± 2.2 days; P = .037 and 4.3 ± 5.2 days; P = NS, respectively) and combination therapy (3.3 ± 1.9 days; P = NS and 3.0 ± 4.0 days; P = .025, respectively). CONCLUSIONS Routine cataract surgery of PXF eyes with nonsteroidal anti-inflammatory drugs (NSAID) alone, or in combination with steroids resulted in faster recovery from surgery and avoidance of PCME compared to steroids alone. ABBREVIATIONS BAB: blood-aqueous barrier; CDVA: corrected distance visual acuity; CDE: cumulative dissipated energy; CSMT: central subfield macular thickness; HRQoL: Health-related quality of life; IOP: intraocular pressure; logMAR: log of the minimum angle of resolution; NSAID: nonsteroidal anti-inflammatory drug; PCME: pseudophakic cystoid macular edema; PXF: pseudoexfoliation syndrome; OCT: optical coherence tomography; t.i.d.: three times a day; VA: visual acuity.
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Affiliation(s)
- Lotta Ilveskoski
- Helsinki Retina Research Group, University of Helsinki , Helsinki, Finland.,Department of Ophthalmology, Helsinki University Hospital , Helsinki, Finland
| | - Claudia Taipale
- Helsinki Retina Research Group, University of Helsinki , Helsinki, Finland.,Department of Ophthalmology, Helsinki University Hospital , Helsinki, Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki , Helsinki, Finland.,Unit of Ophthalmology, Kymenlaakso Central Hospital , Kotka, Finland
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Association of Postoperative Topical Prostaglandin Analog or Beta-Blocker Use and Incidence of Pseudophakic Cystoid Macular Edema. J Glaucoma 2019; 27:402-406. [PMID: 29505438 DOI: 10.1097/ijg.0000000000000929] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article is to determine the association of postoperative topical prostaglandin analog (PGA) or topical beta-blocker use and the incidence of pseudophakic cystoid macular edema (CME). METHODS This was a nested case-control study. All adult patients who underwent cataract surgery between January 1, 2006 and December 31, 2016 and who were enrolled in the PharMetrics Plus database were eligible for inclusion. The association between postoperative topical PGAs (bimatoprost, latanoprost, and travoprost/travoprost-z) or beta-blocker (betaxolol, levobunolol, and timolol) use and the incidence of pseudophakic CME was assessed by conditional logistic regression. RESULTS Five hundred eight cases and 5080 controls were included in the analyses. Incidence of pseudophakic CME was found to be statistically significantly associated with the current postoperative use of both topical PGAs [relative risk (RR), 1.86; 95% confidence interval (CI), 1.04-3.32] and topical beta-blockers (RR, 2.64; 95% CI, 1.08-6.49). Postoperative use of each of bimatoprost (RR, 2.73; 95% CI, 1.35%-5.53%) and travoprost/travoprost-z (RR, 3.16; 95% CI, 1.42-7.03) in the year before diagnosis was demonstrated to be statistically significantly associated with the incidence of pseudophakic CME. This association was not observed to be statistically significant with the postoperative use of latanoprost (RR, 1.55; 95% CI, 0.84-2.88). CONCLUSIONS To the best of our knowledge this is the largest study that has investigated the association between postoperative topical PGA or topical beta-blocker use and the incidence of pseudophakic CME. Postoperative use of both topical PGAs and topical beta-blockers was found to be associated with the incidence of pseudophakic CME.
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16
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Hoffman RS, Braga-Mele R, Donaldson K, Emerick G, Henderson B, Kahook M, Mamalis N, Miller KM, Realini T, Shorstein NH, Stiverson RK, Wirostko B. Cataract surgery and nonsteroidal antiinflammatory drugs. J Cataract Refract Surg 2018; 42:1368-1379. [PMID: 27697257 DOI: 10.1016/j.jcrs.2016.06.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 10/20/2022]
Abstract
Nonsteroidal antiinflammatory drugs (NSAIDs) have become an important adjunctive tool for surgeons performing routine and complicated cataract surgery. These medications have been found to reduce pain, prevent intraoperative miosis, modulate postoperative inflammation, and reduce the incidence of cystoid macular edema (CME). Whether used alone, synergistically with steroids, or for specific high-risk eyes prone to the development of CME, the effectiveness of these medications is compelling. This review describes the potential preoperative, intraoperative, and postoperative uses of NSAIDs, including the potency, indications and treatment paradigms and adverse effects and contraindications. A thorough understanding of these issues will help surgeons maximize the therapeutic benefits of these agents and improve surgical outcomes. FINANCIAL DISCLOSURE Proprietary or commercial disclosures are listed after the references.
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17
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Controversies on the Use of Glaucoma Medications During Cataract Surgery. J Glaucoma 2018; 27:e195. [PMID: 30180016 DOI: 10.1097/ijg.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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RESOLUTION OF A MACULAR HOLE COMPLICATING A PSEUDOPHAKIC MACULAR EDEMA WITH NONSURGICAL TREATMENT. Retin Cases Brief Rep 2018; 12:131-135. [PMID: 27787409 DOI: 10.1097/icb.0000000000000446] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pseudophakic cystoid macular edema (PCME) is a common complication of cataract surgery. We report the management of a case presenting with PCME in his left eye complicated by a full-thickness macular hole (MH). Four weeks after a cataract surgery on his left eye, a 75-year-old man presented with a vision loss on the same eye (best-corrected visual acuity: 20/64). A PCME complicated by a full-thickness MH was diagnosed. After oral acetazolamide treatment, the PCME completely regressed and the full-thickness MH closed after medical treatment. CONCLUSION Macular edema may rarely lead to MHs, by inducing mechanical changes and probable inflammatory mechanisms as well as a thinning of the fovea. We report a case of spontaneous closure of MH complicating a PCME, with medical treatment.
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19
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Giambruni JM, Pagano C, Ortiz Basso T, Burchakchi AI, Pozzoni MC, Diamint DV, Challiol CF, Gossn G, Boietti B. Topical prostaglandin analogues and development of epiretinal membrane. ACTA ACUST UNITED AC 2018; 93:169-173. [PMID: 29398231 DOI: 10.1016/j.oftal.2017.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/09/2017] [Accepted: 12/11/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine whether patients with glaucoma and epiretinal membrane (ERM) use a greater proportion of prostaglandin analogues (PA) than a control group of patients with glaucoma without ERM. METHOD A retrospective study of cases and controls was conducted in order to determine whether patients with glaucoma and ERM used a greater proportion of PA than a control group of patients with glaucoma without ERM. The diagnosis of de ERM was made by clinical examination and optical coherence tomography. RESULTS The mean age of the cases was 77 years (SD: 8.68; 95% CI: 74.3-79.4), compared to the controls with 63 years (SD: 16.6; 95% CI: 70.1-78.5). The cases included 50% (n=26) men and 50% women (n=26), whereas in the controls 25.4% (n=16) of the cases were men and 74.6% (n=47) women. PA treatment was used in 59.6% (n=31) and 60.3% (n=38) of the cases and controls, respectively. There was no statistically significant difference in PA use between the 2groups (P=.939). CONCLUSIONS In this study, an association between the use of AP and the development of ERM could not be demonstrated.
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Affiliation(s)
- J M Giambruni
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - C Pagano
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - T Ortiz Basso
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A I Burchakchi
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M C Pozzoni
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - D V Diamint
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - C F Challiol
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G Gossn
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - B Boietti
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Altintaş Ö, Yüksel N, Karabaş V, Demìrcì G. Cystoid Macular Edema Associated with Latanoprost after Uncomplicated Cataract Surgery. Eur J Ophthalmol 2018. [DOI: 10.1177/112067210501500128] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ö. Altintaş
- Department of Ophthalmology, Medical Faculty, Kocaeli University, Kocaeli - Turkey
| | - N. Yüksel
- Department of Ophthalmology, Medical Faculty, Kocaeli University, Kocaeli - Turkey
| | - V.L. Karabaş
- Department of Ophthalmology, Medical Faculty, Kocaeli University, Kocaeli - Turkey
| | - G. Demìrcì
- Department of Ophthalmology, Medical Faculty, Kocaeli University, Kocaeli - Turkey
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21
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Razeghinejad MR. The Effect of Latanaprost on Intraocular Inflammation and Macular Edema. Ocul Immunol Inflamm 2017; 27:181-188. [PMID: 29028372 DOI: 10.1080/09273948.2017.1372485] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
There is debate concerning whether the use of Latanoprost in early postoperative period of cataract surgery and in glaucoma patients with uveitis as it may aggravate the inflammation and results in macular edema (ME), because of blood-ocular barrier disruption. However, there is no solid evidence for disruption of blood-ocular barrier with Latanoprost and aggravation of uveitis or ME formation. Similar to pseudophakic ME, the imaging ME in cases claimed to be secondary to Latanoprost is greater than clinical ME, happens mostly in complicated surgeries, and the vast majority resolve within weeks to months with using a non-steroidal anti-inflammatory drug. The current literature suggests that Latanoprost can be used in patients with uveitis and early after cataract surgery with or without concomitant topical non-steroidal anti-inflammatory drugs that are currently used by many ophthalmologists as a preventive measure for ME even in non-glaucoma uncomplicated cataract surgeries.
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Affiliation(s)
- M Reza Razeghinejad
- a Glaucoma Service , Wills Eye Institute , Philadelphia , Pennsylvania , USA
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22
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Lee KM, Lee EJ, Kim TW, Kim H. Pseudophakic Macular Edema in Primary Open-Angle Glaucoma: A Prospective Study Using Spectral-Domain Optical Coherence Tomography. Am J Ophthalmol 2017; 179:97-109. [PMID: 28499706 DOI: 10.1016/j.ajo.2017.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/27/2017] [Accepted: 05/01/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the incidence of and risk factors for pseudophakic macular edema (PME) after uncomplicated cataract surgery in primary open-angle glaucoma (POAG) using spectral-domain optical coherence tomography (SDOCT). DESIGN Cohort study. METHODS Macular retinal thickness was evaluated using SDOCT at 1 week before surgery and at 1, 3, 6, and 12 months postoperatively, in 70 POAG and 68 control eyes. Forty-three healthy subjects without impaired vision or cystoid PME were recruited separately as pilot samples to define significant PME. Significant PME was defined as an increase in the average thickness exceeding the mean + 3 standard deviations of the increase shown in the pilot samples. RESULTS Significant PME (increase in the foveal 3-mm zone thickness of >19.5 μm) was observed in 31 (44%) eyes with POAG and in 14 (21%) control eyes (P = .003). The extent of PME was maximal at 3 months postoperatively and decreased gradually until 12 months. Regression tree analysis revealed that the risk of PME was the greatest in the POAG group using prostaglandin analogue (PGA) (odds ratio [OR] = 5.51), followed by POAG not using PGA (OR = 1.70), and control group (OR = 1.0). Risk factors for PME were younger age in all groups (OR = 1.07), systemic hypertension in PGA users (OR = 6.42), higher untreated IOP in PGA nonusers (OR = 1.09) and male sex (OR = 14.06) and diabetes mellitus (OR = 16.71) in the control group. CONCLUSIONS The incidence of PME as observed by SDOCT was higher than previously reported after uncomplicated cataract surgery. Eyes with POAG were at greater risk for PME, which was mainly associated with perioperative PGA use.
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Affiliation(s)
- Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyunjoong Kim
- Department of Applied Statistics, Yonsei University, Seoul, South Korea
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23
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Makri OE, Tsapardoni FN, Plotas P, Ifantis N, Xanthopoulou PT, Georgakopoulos CD. Cystoid macular edema associated with preservative-free latanoprost after uncomplicated cataract surgery: case report and review of the literature. BMC Res Notes 2017; 10:127. [PMID: 28320481 PMCID: PMC5360021 DOI: 10.1186/s13104-017-2448-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/08/2017] [Indexed: 11/29/2022] Open
Abstract
Background Cystoid macular edema associated with latanoprost administration has been reported in patients after complicated cataract surgery with coexisting risk factors. We present the first case of preservative free latanoprost associated cystoid macular edema that occurred many months after uncomplicated cataract surgery. Case presentation A 65-year old Caucasian female presented in the Outpatients Clinic complaining of reduced vision and metamorphopsia in the right eye. She had undergone uneventful phacoemulsification 19 months ago in the right eye and was under treatment with preservative free latanoprost eye drops for the last 7 months for ocular hypertension. Her remaining medical and ocular history were otherwise unremarkable. Cystoid macular edema with serous retinal detachment was diagnosed in the right eye using optical coherence tomography and fluorescein angiography. Latanoprost was discontinued and brinzolamide and nepafenac eye drops were administered in the right eye. Two months later, cystoid macular edema completely resolved with restoration of visual acuity. Nepafenac eye drops were administered for another 2 months. Eight months after latanoprost cessation optical coherence demonstrated no sign of cystoid macular edema whereas a subtle epiretinal membrane was noted. Conclusions Cystoid macular edema may potentially occur in patients receiving preservative free latanoprost. More interestingly, in our case it was diagnosed in a patient with a long standing pseudophakia after uncomplicated phacoemulsification. No obvious risk factor for macular edema development was recognized. Prompt diagnosis and latanoprost discontinuation resulted in complete resolution of the cystoid macular edema and functional restoration of the eye.
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Affiliation(s)
- Olga E Makri
- Department of Ophthalmology, Medical School, University of Patras, 265 04, Patras, Greece
| | - Foteini N Tsapardoni
- Department of Ophthalmology, Medical School, University of Patras, 265 04, Patras, Greece
| | - Panagiotis Plotas
- Department of Ophthalmology, Medical School, University of Patras, 265 04, Patras, Greece
| | - Nikistratos Ifantis
- Department of Ophthalmology, Medical School, University of Patras, 265 04, Patras, Greece
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Funke S, Perumal N, Bell K, Pfeiffer N, Grus FH. The potential impact of recent insights into proteomic changes associated with glaucoma. Expert Rev Proteomics 2017; 14:311-334. [PMID: 28271721 DOI: 10.1080/14789450.2017.1298448] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Glaucoma, a major ocular neuropathy, is still far from being understood on a molecular scale. Proteomic workflows revealed glaucoma associated alterations in different eye components. By using state-of-the-art mass spectrometric (MS) based discovery approaches large proteome datasets providing important information about glaucoma related proteins and pathways could be generated. Corresponding proteomic information could be retrieved from various ocular sample species derived from glaucoma experimental models or from original human material (e.g. optic nerve head or aqueous humor). However, particular eye tissues with the potential for understanding the disease's molecular pathomechanism remains underrepresented. Areas covered: The present review provides an overview of the analysis depth achieved for the glaucomatous eye proteome. With respect to different eye regions and biofluids, proteomics related literature was found using PubMed, Scholar and UniProtKB. Thereby, the review explores the potential of clinical proteomics for glaucoma research. Expert commentary: Proteomics will provide important contributions to understanding the molecular processes associated with glaucoma. Sensitive discovery and targeted MS approaches will assist understanding of the molecular interplay of different eye components and biofluids in glaucoma. Proteomic results will drive the comprehension of glaucoma, allowing a more stringent disease hypothesis within the coming years.
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Affiliation(s)
- Sebastian Funke
- a Experimental Ophthalmology , University Medical Center , Mainz , Germany
| | - Natarajan Perumal
- a Experimental Ophthalmology , University Medical Center , Mainz , Germany
| | - Katharina Bell
- a Experimental Ophthalmology , University Medical Center , Mainz , Germany
| | - Norbert Pfeiffer
- a Experimental Ophthalmology , University Medical Center , Mainz , Germany
| | - Franz H Grus
- a Experimental Ophthalmology , University Medical Center , Mainz , Germany
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25
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McCafferty S, Harris A, Kew C, Kassm T, Lane L, Levine J, Raven M. Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo. BMC Ophthalmol 2017; 17:16. [PMID: 28219426 PMCID: PMC5319126 DOI: 10.1186/s12886-017-0405-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/25/2017] [Indexed: 03/12/2024] Open
Abstract
Background Define the effectiveness of a topical non-steroidal anti-inflammatory drug (NSAID) added to topical steroid use after uncomplicated phacoemulsification for the prevention of pseudophakic cystoid macular edema (PCME) using a prospective, randomized, double-masked, placebo-controlled clinical study. Methods Eyes (1000) were randomized to placebo (497) or nepafenac 0.3% (503) used once daily, post-operatively for 5 weeks at two ophthalmology clinics. Diagnosis of PCME was made by clinical, ocular coherence tomography (OCT), and with fluorescein angiography confirmation. Correlation of PCME to NSAID use and the presence of pre-operative risk factors for PCME were assessed including, contralateral PCME, diabetic retinopathy, retinal vein occlusion, macular hole, epiretinal membrane, macular degeneration, retinal detachment repair, and prostaglandin use. Results PCME was the most common complication associated with routine cataract surgery (4.2% with PCME risk factors, 2.0% with risk factors excluded). Topical nepafenac 0.3% significantly reduces the incidence of PCME compared to placebo when used after routine cataract surgery (p = .0001). When patients with pre-operative risk factors are excluded, the incidence of PCME between treatment and placebo groups is equivalent (p = 0.31). PCME relative risk (RR) was most significant in contralateral PCME (RR 19.5), diabetic retinopathy (RR 13.1), retinal vein occlusion (RR 12.9), macular hole (RR 7.7), and epiretinal membrane (RR 5.7). Prostaglandin use and previous retinal detachment were not shown to increase risk. Conclusion Pseudophakic cystoid macular edema is common after phacoemulsification cataract surgery. Topical nepafenac 0.3% reduces PCME in patients with pre-operative risk factors for PCME compared to placebo but shows no benefit in patients without pre-operative risk factors. Trial registration NIH ClincalTrials.gov retrospectively registered January 15, 2017, NCT03025945.
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Affiliation(s)
- Sean McCafferty
- Arizona Eye Consultants, 355 N. Silverbell Ave, Tucson, AZ, 85745, USA. .,University of Arizona, 6422 E. Speedway Ave, Tucson, AZ, 85710, USA.
| | - April Harris
- Retina Associates of Tucson, 6561 E. Carondelet Dr, Tucson, AZ, 85710, USA.,University of Arizona, 6422 E. Speedway Ave, Tucson, AZ, 85710, USA
| | - Corin Kew
- Arizona Eye Consultants, 355 N. Silverbell Ave, Tucson, AZ, 85745, USA
| | - Tala Kassm
- Arizona Eye Consultants, 355 N. Silverbell Ave, Tucson, AZ, 85745, USA
| | - Lisa Lane
- Arizona Eye Consultants, 355 N. Silverbell Ave, Tucson, AZ, 85745, USA
| | - Jason Levine
- Arizona Eye Consultants, 355 N. Silverbell Ave, Tucson, AZ, 85745, USA.,University of Arizona, 6422 E. Speedway Ave, Tucson, AZ, 85710, USA
| | - Meisha Raven
- Arizona Eye Consultants, 355 N. Silverbell Ave, Tucson, AZ, 85745, USA
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Selen F, Tekeli O, Yanık Ö. Assessment of the Anterior Chamber Flare and Macular Thickness in Patients Treated with Topical Antiglaucomatous Drugs. J Ocul Pharmacol Ther 2017; 33:170-175. [PMID: 28165835 DOI: 10.1089/jop.2016.0128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To determine the changes in the anterior chamber flare and central macular thickness (CMT) under topical antiglaucomatous therapy. METHODS This study included 121 eyes of 73 patients and 36 eyes of 18 controls. Glaucoma patients were divided into 3 groups (timolol maleate, latanoprost, and bimatoprost). Control eyes did not receive any medications. Flare and CMT measurements were performed at baseline and follow-up visits (15th day, and 1st, 3rd, 6th, and 12th month). RESULTS Statistically significant increases were detected in the flare values in the bimatoprost and latanoprost groups (P < 0.001, P = 0.011, respectively). Significant increases were also found in CMT values measured in these 2 groups (P < 0.001, P = 0.002, respectively). However, increased flare and CMT values were not clinically manifested as uveitis and macular edema. Flare and CMT values did not change statistically in the timolol maleate and control groups. CONCLUSIONS Although the use of prostaglandin (PG) analogs was found to be associated with increased flare and CMT, these increases were not clinically significant. PG analog monotherapy may be safely and effectively used in the treatment of glaucoma.
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Affiliation(s)
- Fırat Selen
- Department of Ophthalmology, Faculty of Medicine, Ankara University , Ankara, Turkey
| | - Oya Tekeli
- Department of Ophthalmology, Faculty of Medicine, Ankara University , Ankara, Turkey
| | - Özge Yanık
- Department of Ophthalmology, Faculty of Medicine, Ankara University , Ankara, Turkey
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27
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Sawa M. Laser flare-cell photometer: principle and significance in clinical and basic ophthalmology. Jpn J Ophthalmol 2016; 61:21-42. [PMID: 27888376 DOI: 10.1007/s10384-016-0488-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/07/2016] [Indexed: 12/19/2022]
Abstract
A slit-lamp examination is an indispensable and essential clinical evaluation method in ophthalmology, but, it is qualitative subjective. To complement its weaknesses in making a quantitative evaluation of flare intensity and number of cells in the aqueous humor in the eye, we invented the laser flare-cell photometer in 1988. The instrument enables a non-invasive quantitative evaluation of flare intensity and number of cells in the aqueous with good accuracy and repeatability as well as maneuverability equal to slit-lamp microscopy. The instrument can elucidate the pathophysiology in the blood-aqueous barrier (BAB) function in a variety of ocular disorders. The accuracy of the instrument makes it possible to investigate not only the pathophysiology of intraocular disorders but also the effects of various drugs and surgical procedures in BAB. The instrument does not only lighten the burden on patients in clinical examinations and study but it also helps minimize the sacrifice of experimental animals and improves the reliability of the results by minimizing inter-individual variations through its good repeatability. Here I shall relate how the instrument has been applied to clinical and basic studies in ophthalmology and what novel knowledge its application contributed to pathophysiology in ophthalmology.
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Affiliation(s)
- Mitsuru Sawa
- Public Interest Incorporated Foundation Isshinkai, 3-37-8 Hongo, Bunkyo, Tokyo, 113-0033, Japan. .,Emeritus Professor, Nihon University, Tokyo, Japan.
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Tofflemire K, Whitley EM, Allbaugh R, Ben-Shlomo G, Griggs A, Strong T, Whitley RD. Effect of topical ophthalmic latanoprost 0.005% solution alone and in combination with diclofenac 0.1% solution in healthy horses: a pilot study. Vet Ophthalmol 2016; 20:398-404. [DOI: 10.1111/vop.12439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kyle Tofflemire
- Department of Veterinary Clinical Sciences; Iowa State University College of Veterinary Medicine; Ames Iowa 50011 USA
| | | | - Rachel Allbaugh
- Department of Veterinary Clinical Sciences; Iowa State University College of Veterinary Medicine; Ames Iowa 50011 USA
| | - Gil Ben-Shlomo
- Department of Veterinary Clinical Sciences; Iowa State University College of Veterinary Medicine; Ames Iowa 50011 USA
| | - Angela Griggs
- Department of Veterinary Clinical Sciences; Iowa State University College of Veterinary Medicine; Ames Iowa 50011 USA
| | - Travis Strong
- Department of Veterinary Clinical Sciences; Iowa State University College of Veterinary Medicine; Ames Iowa 50011 USA
| | - R. David Whitley
- Department of Veterinary Clinical Sciences; Iowa State University College of Veterinary Medicine; Ames Iowa 50011 USA
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Keilani C, Halalchi A, Wakpi Djeugue D, Regis A, Abada S. Evaluation of best corrected visual acuity and central macular thickness after intravitreal dexamethasone implant injections in patients with Irvine-Gass syndrome: A retrospective study of six cases. Therapie 2016; 71:457-465. [PMID: 27203164 DOI: 10.1016/j.therap.2016.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/16/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Irvine-Gass syndrome is a macular edema (ME) that specifically occurs after cataract surgery. Its incidence varies from 0.2-2%. The purpose of this study is to evaluate the effectiveness of intravitreal dexamethasone implant injections in patients with Irvine-Gass syndrome. METHODS Patients with ME secondary to cataract surgery who underwent intravitreal injections of dexamethasone implant between December 2011 to October 2014 at François-Quesnay hospital (Mantes-la-Jolie, France) were retrospectively reviewed. The patients were followed for at least 10 months. All the patients were handled by intravitreal injection of dexamethasone in the eye of study among which some resisted to a preliminary treatment by non-steroidal anti-inflammatory drug (NSAID) and acetazolamide. The patients were examined each month. The patients were again handled by intravitreal injection of dexamethasone if they presented a recurrence. The primary endpoint of the study was determined on best corrected visual acuity (BCVA) using early diabetic retinopathy study (ETDRS) scale and central macular thickness (CMT) [μm] using optical coherence tomography (OCT) 3 and 6 months after the first injection. Secondary endpoints were the number of recurrences, the number of injections, the duration average before the first recurrence, the BCVA 10 months after the first injection and the tolerance. RESULTS Six eyes of six patients were studied. At baseline, the mean (standard deviation [SD]) of the BCVA was 59.8±11. Three months after the first injection, the mean (SD) of the BCVA showed a statistically significant increase to 72.2±8.6 (P=0.03). Six months after the first injection, the mean (SD) of the BCVA showed a statistically significant increase to 72±11.8 (P=0.03). Concerning the CMT, the mean (SD) was 495.6±135.2 before treatment. Three months after the first injection, the mean (SD) of the CMT showed a statistically significant decrease to 268.6±57.8 (P=0.03). Six months after the first injection, the mean (SD) of the CMT showed a significant decrease to 350.1±56.3 (P=0.09). CONCLUSION In this study, both mean BCVA and mean CMT had significantly improved from baseline after treatment with dexamethasone implant in patients with Irvine-Gass syndrome.
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Affiliation(s)
- Chafik Keilani
- Department of vascular neurology, hôpital universitaire de la Pitié-Salpêtrière, faculty of medicine Pierre-et-Marie-Curie, 75013 Paris, France.
| | - Aziz Halalchi
- Department of ophthalmology, hôpital François-Quesnay, 78201 Mantes-la-Jolie, France
| | - Désiré Wakpi Djeugue
- Department of ophthalmology, hôpital François-Quesnay, 78201 Mantes-la-Jolie, France
| | - Anne Regis
- Department of ophthalmology, hôpital François-Quesnay, 78201 Mantes-la-Jolie, France
| | - Samir Abada
- Department of ophthalmology, hôpital François-Quesnay, 78201 Mantes-la-Jolie, France
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Kishi S. Vitreous anatomy and the vitreomacular correlation. Jpn J Ophthalmol 2016; 60:239-73. [DOI: 10.1007/s10384-016-0447-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
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Niyadurupola N, Broadway DC. Special considerations for glaucoma management in the elderly. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1190643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wielders LHP, Lambermont VA, Schouten JSAG, van den Biggelaar FJHM, Worthy G, Simons RWP, Winkens B, Nuijts RMMA. Prevention of Cystoid Macular Edema After Cataract Surgery in Nondiabetic and Diabetic Patients: A Systematic Review and Meta-Analysis. Am J Ophthalmol 2015; 160:968-981.e33. [PMID: 26232601 DOI: 10.1016/j.ajo.2015.07.032] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the optimum medical strategy to prevent cystoid macular edema (CME) after cataract surgery. DESIGN Systematic review and meta-analysis. METHODS setting: Cochrane, MEDLINE, and EMBASE databases were searched to identify eligible randomized controlled trials (RCTs). STUDY POPULATION RCTs comparing medical strategies to prevent CME after uncomplicated cataract surgery in nondiabetic and diabetic patients. OBSERVATION PROCEDURES Data were extracted by 2 authors independently. Quality of individual RCTs was assessed using the Cochrane Collaboration's tool for assessing risk of bias and Delphi criteria. MAIN OUTCOME MEASURES Odds of developing CME within 3 months postoperatively and foveal thickness, macular volume and corrected distance visual acuity change within 3 months postoperatively, as compared to baseline. RESULTS Seventeen trials reported incidence rates. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) significantly reduced the odds of developing CME as compared to topical corticosteroids in nondiabetic (odds ratio [OR] 0.11; 95% confidence interval [95% CI] 0.03-0.37) and mixed populations (OR 0.05; 95% CI 0.02-0.11). A combination of topical corticosteroids and NSAIDs significantly reduced the odds of developing CME as compared to topical corticosteroids in nondiabetic (OR 0.21; 95% CI 0.10-0.44) and diabetic patients (OR 0.17; 95% CI 0.05-0.50). Intravitreal corticosteroid or anti-vascular endothelial growth factor injections did not show any additional benefit in diabetic subjects. CONCLUSIONS Topical NSAIDs significantly reduced the odds of developing CME, as compared to topical corticosteroids, in nondiabetic and mixed populations. A combination of topical NSAIDs and corticosteroids reduced the odds of developing CME in nondiabetic and diabetic patients, as compared to topical corticosteroids.
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Affiliation(s)
- Laura H P Wielders
- University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, Netherlands.
| | - Verena A Lambermont
- University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jan S A G Schouten
- University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, Netherlands
| | | | - Gill Worthy
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | - Rob W P Simons
- University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Maastricht, Netherlands
| | - Rudy M M A Nuijts
- University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, Netherlands
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Guo S, Patel S, Baumrind B, Johnson K, Levinsohn D, Marcus E, Tannen B, Roy M, Bhagat N, Zarbin M. Management of pseudophakic cystoid macular edema. Surv Ophthalmol 2014; 60:123-37. [PMID: 25438734 DOI: 10.1016/j.survophthal.2014.08.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 08/24/2014] [Accepted: 08/26/2014] [Indexed: 01/08/2023]
Abstract
Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Acute PCME may resolve spontaneously, but some patients will develop chronic macular edema that affects vision and is difficult to treat. This disease was described more than 50 years ago, and there are multiple options for clinical management. We discuss mechanisms, clinical efficacy, and adverse effects of these treatment modalities. Topical non-steroidal anti-inflammatory agents and corticosteroids are widely used and, when combined, may have a synergistic effect. Intravitreal corticosteroids and anti-vascular endothelial growth factor (anti-VEGF) agents have shown promise when topical medications either fail or have had limited effects. Randomized clinical studies evaluating anti-VEGF agents are needed to fully evaluate benefits and risks. When PCME is either refractory to medical therapy or is associated with significant vitreous involvement, pars plana vitrectomy has been shown to improve outcomes, though it is associated with additional risks.
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Affiliation(s)
- Suqin Guo
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA.
| | - Shriji Patel
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Ben Baumrind
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Keegan Johnson
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Daniel Levinsohn
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Edward Marcus
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Brad Tannen
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Monique Roy
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Neelakshi Bhagat
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Marco Zarbin
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
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Schweitzer C, Orignac I, Praud D, Chatoux O, Colin J. Glistening in glaucomatous eyes: visual performances and risk factors. Acta Ophthalmol 2014; 92:529-34. [PMID: 24119141 DOI: 10.1111/aos.12276] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 08/22/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyse risk factors and visual performances of glaucomatous eyes with glistening in the intra-ocular lens (IOL). METHODS Prospective study performed between November 2010 and April 2011 and involving 67 consecutive glaucomatous eyes (47 patients), who previously had a phacoemulsification with a hydrophobic acrylic IOL implanted in the capsular bag. Glistening was classified in three groups of severity grade: G0 (<50 microvacuoles per mm(2) ), G1 (50-150 microvacuoles per mm(2) ), and G2 (>150 microvacuoles per mm(2) ). All eyes underwent a best-corrected visual acuity evaluation (BCVA, LogMAR scale), a complete clinical examination, a visual field test, a contrast sensitivity evaluation and a wavefront analysis of high-order aberrations (HOAs) using a Shack-Hartmann aberrometer. Eyes with a posterior capsular opacification and a BCVA>0.30 LogMAR were excluded. RESULTS Twenty six eyes (38.8%) had a grade 0, 12 eyes (17.9%) a grade 1 and 29 eyes (43.3%) a grade 2 of glistening severity grade. The mean follow-up after cataract surgery was 35.2 ± 24.2 months and was significantly higher for G1 and G2 groups (p < 0.001). A higher number of topical glaucoma medication were associated with a higher glistening severity grade (p < 0.05). G1 and G2 groups had significantly lower mean contrast sensitivity values at high spatial frequencies and significantly higher loss variance (LV) values of the visual field test (p < 0.05). There was no significant difference in mean BCVA between groups (p = 0.455). CONCLUSIONS In glaucomatous eyes, glistening increased with time was associated with the number of topical glaucoma medications daily instilled and altered visual performances. It should be a consideration for glaucoma patients who are more likely to develop glistening within the IOL optic.
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Affiliation(s)
- Cedric Schweitzer
- Ophthalmology Department; University Hospital Pellegrin; Bordeaux Cedex France
| | - Isabelle Orignac
- Ophthalmology Department; University Hospital Hotel-Dieu; Nantes Cedex France
| | - Delphine Praud
- Ophthalmology Department; University Hospital Pellegrin; Bordeaux Cedex France
| | - Olivier Chatoux
- Ophthalmology Department; University Hospital Pellegrin; Bordeaux Cedex France
| | - Joseph Colin
- Ophthalmology Department; University Hospital Pellegrin; Bordeaux Cedex France
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Abstract
Glaucoma is a chronic, progressive disease in which retinal ganglion cells disappear and subsequent, gradual reductions in the visual field ensues. Glaucoma eye drops have hypotensive effects and like all other medications are associated with adverse effects. Adverse reactions may either result from the main agent or from preservatives used in the drug vehicle. The preservative benzalkonium chloride, is one such compound that causes frequent adverse reactions such as superficial punctate keratitis, corneal erosion, conjunctival allergy, and conjunctival injection. Adverse reactions related to main hypotensive agents have been divided into those affecting the eye and those affecting the entire body. In particular, β-blockers frequently cause systematic adverse reactions, including bradycardia, decrease in blood pressure, irregular pulse and asthma attacks. Prostaglandin analogs have distinctive local adverse reactions, including eyelash bristling/lengthening, eyelid pigmentation, iris pigmentation, and upper eyelid deepening. No systemic adverse reactions have been linked to prostaglandin analog eye drop usage. These adverse reactions may be minimized when they are detected early and prevented by reducing the number of different eye drops used (via fixed combination eye drops), reducing the number of times eye drops are administered, using benzalkonium chloride-free eye drops, using lower concentration eye drops, and providing proper drop instillation training. Additionally, a one-time topical medication can be given to patients to allow observation of any adverse reactions, thereafter the preparation of a topical medication with the fewest known adverse reactions can be prescribed. This does require precise patient monitoring and inquiries about patient symptoms following medication use.
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Rønbeck M, Behndig A, Taube M, Koivula A, Kugelberg M. Comparison of glistenings in intraocular lenses with three different materials: 12-year follow-up. Acta Ophthalmol 2013; 91:66-70. [PMID: 22035345 DOI: 10.1111/j.1755-3768.2011.02277.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the degree of lens glistenings associated with three intraocular lenses (IOLs) of different materials and examine the relationship between the dioptric power of the optics and lens glistenings in a long-term study. SETTING St. Erik Eye Hospital, Stockholm, Sweden. METHODS Forty-six eyes of 46 patients underwent standard phacoemulsification and implantation with a heparin-surface-modified (HSM) polymethylmethacrylate (PMMA) IOL, a silicone IOL or a hydrophobic acrylic IOL. Evaluations of the patients and the glistenings were conducted 11.3-13.4 years postoperatively. The glistenings were examined using Scheimpflug imaging and subsequently analysed using an image analysis program. RESULTS The median follow-up time was 12.2 years (range, 11.3-13.4). The hydrophobic acrylic IOL had significantly more lens glistenings than the silicone (p = 0.003) and the PMMA (p = 0.000) IOLs. The silicone IOL had significantly more lens glistenings than the PMMA lens (p = 0.048). The IOL power did not affect the degree of lens glistenings in the hydrophobic acrylic IOL group (p = 0.64). The other groups had too little lens glistenings to evaluate the relationship. CONCLUSION In this long-term follow-up study, the hydrophobic acrylic IOL had a significantly higher degree of lens glistenings compared to the silicone and PMMA IOLs. The PMMA IOL had almost no lens glistenings. The IOL dioptric power was not significantly correlated with the degree of lens glistenings associated with the hydrophobic acrylic IOL.
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Dams I, Wasyluk J, Prost M, Kutner A. Therapeutic uses of prostaglandin F(2α) analogues in ocular disease and novel synthetic strategies. Prostaglandins Other Lipid Mediat 2013; 104-105:109-21. [PMID: 23353557 DOI: 10.1016/j.prostaglandins.2013.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 12/27/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
Abstract
The pharmacological management of glaucoma and ocular hypertension has significantly changed over the last 18 years with the introduction of PGF2α analogues, more specifically latanoprost (6), travoprost (8), bimatoprost (10) and tafluprost (12). Prostanoids are currently the first-line medicines among ocular antihypertensive drugs in terms of efficacy, safety, patient compliance and medical economy. Their ability to effectively reduce intraocular pressure with once-per-day dosing, ocular tolerability comparable to timolol and general lack of systemic adverse effects have made them the mainstay of pharmacological therapy for glaucoma and ocular hypertension all over the world. The present review reports a novel, convergent and highly diastereoselective method for the synthesis of PGF2α analogues from the structurally advanced prostaglandin phenylsulfone (5Z)-(+)-15 and new ω-chain synthons. The biochemistry, clinical efficacy and side effects of four commercially available PGF2α analogues, currently used as first-line agents for reducing intraocular pressure in patients with glaucoma or ocular hypertension, are also discussed.
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Affiliation(s)
- Iwona Dams
- R&D Chemistry Department, Pharmaceutical Research Institute, Rydygiera 8, 01-793 Warsaw, Poland.
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Matsuura K, Sasaki S, Uotani R. Successful treatment of prostaglandin-induced cystoid macular edema with subtenon triamcinolone. Clin Ophthalmol 2012; 6:2105-8. [PMID: 23269859 PMCID: PMC3529656 DOI: 10.2147/opth.s39542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Cystoid macular edema (CME) is associated with the use of prostaglandin eye drops after cataract surgery. The study aim was to report on the treatment of two CME patients with subtenon triamcinolone injections. Methods Case one was a 70-year-old woman who underwent uneventful cataract surgery. Travoprost was administrated at 10 weeks after surgery, and CME occurred at 13 weeks after surgery. Case two was an 85-year-old man who underwent intraocular lens extraction and an intraocular lens suture operation. Latanoprost was readministered after the surgery. The patient complained of blurred vision 3 years later. Results For both cases, discontinuation of the prostaglandin eye drops, subsequent initiation of treatment with diclofenac eye drops, and subtenon injection of triamcinolone was followed by the rapid disappearance of the CME. After the CME had disappeared for 3 months, the prostaglandin eye drops were resumed. Diclofenac was added in case two. No CME recurrence was seen in either case over 2 years. Conclusion Subtenon triamcinolone injection can be effective for CME associated with prostaglandin eye liquid after cataract surgery. Prostaglandin eye liquid that causes CME is not necessarily precluded for future use if administered under careful observation.
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Digiuni M, Fogagnolo P, Rossetti L. A review of the use of latanoprost for glaucoma since its launch. Expert Opin Pharmacother 2012; 13:723-45. [PMID: 22348427 DOI: 10.1517/14656566.2012.662219] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Prostaglandins are increasingly used as first choice treatment for glaucoma because they are highly effective, lack relevant systemic side effects and require just once-daily administration. Latanoprost is an ester prodrug analog of prostaglandin F2α, which reduces intraocular pressure (IOP) by increasing uveoscleral outflow. Latanoprost 0.005% has received European and US approval as the first-line drug for reducing IOP in patients with open-angle glaucoma or ocular hypertension. Following the recent patent expiry for Xalatan®, a number of latanoprost generics have entered the glaucoma market. AREAS COVERED This review, achieved through PubMed and Medline research methods, describes the composition, pharmacokinetics, mode of action, efficacy, side effects and safety profile of latanoprost. EXPERT OPINION Latanoprost was the first prostaglandin analog introduced in glaucoma management and it dramatically changed the market of the disease thanks to its efficacy and safety. Conjunctival hyperemia, which is commonly found after latanoprost use, is associated with a minor efficacy and duration of trabeculectomy; yet, from the ophthalmologist's perspective, this side effect seems largely counterbalanced by the high efficacy and safety of this compound. It is always advisable to consider the pro-inflammatory mode of action of latanoprost because this may have negative effects in particular patients (i.e., those with uveitis and cystoid macular edema) for whom caution and close follow-up is necessary.
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Affiliation(s)
- Maurizio Digiuni
- University of Milan, Eye Clinic, San Paolo Hospital, Via di Rudinì 8, 20142 Milano, Italy
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Lobo C. Pseudophakic Cystoid Macular Edema. Ophthalmologica 2012; 227:61-7. [DOI: 10.1159/000331277] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 11/19/2022]
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Abstract
Glaucoma is a disease process characterized by progressive optic nerve damage and corresponding visual field loss. It may be further categorized into either primary open-angle glaucoma or secondary glaucoma. These secondary glaucomas include glaucomas associated with uveitis and inflammation. Prostaglandin analogs (PGA) have been used to help lower intraocular pressure (IOP) in these often difficult to manage eyes. However, controversy exists concerning their use in uveitic patients due to the theoretically higher risk of anterior uveitis, development of cystoid macular edema (CME), and reactivation of herpes simplex keratitis (HSK). There is little evidence that PGA disrupt the blood-aqueous barrier and only anecdotal evidence suggesting an increased risk of these rare findings. PGA may be used in uveitic glaucoma when other topical treatments have not lowered IOP to the patient's target range.
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Affiliation(s)
- Michael B Horsley
- Glaucoma Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
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Prostaglandin-induced cystoid macular edema following routine cataract extraction. J Ophthalmol 2010; 2010:690707. [PMID: 21076526 PMCID: PMC2975071 DOI: 10.1155/2010/690707] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Accepted: 07/30/2010] [Indexed: 11/18/2022] Open
Abstract
To our knowledge, we are reporting the first case of a 59-year-old man who developed recurrent CME with three separate trials of three different prostaglandin class drugs following uncomplicated phacoemulsification with intraocular lens implantation. Despite multiple reports of individual prostaglandin (PG) analogues being suggested as the cause of CME, there are no recommendations regarding withholding these medications in the perioperative period. Our
patient first developed CME OD 4-months post uncomplicated cataract extraction. XALATAN (Latanoprost) had been restarted after surgery and discontinued at onset of CME. While off XALATAN (Latanoprost), the patient's CME resolved, but his IOP rose. The patient was started on LUMIGAN (Bimatoprost) to control the IOP, but within weeks his CME recurred. The patient's CME was again treated and his IOP remained acceptable, but then progressively increased. TRAVATAN (Travoprost) was attempted, but he presented with a third round of CME. Definitive conclusions about causal relationships cannot be made without well-designed, prospective clinical trials addressing this issue.
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Lee AJ, McCluskey P. Clinical utility and differential effects of prostaglandin analogs in the management of raised intraocular pressure and ocular hypertension. Clin Ophthalmol 2010; 4:741-64. [PMID: 20689791 PMCID: PMC2915861 DOI: 10.2147/opth.s10441] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Indexed: 11/28/2022] Open
Abstract
Prostaglandin analogs (PGA) are powerful topical ocular hypotensive agents available for the treatment of elevated intraocular pressure (IOP). Latanoprost 0.005% and travoprost 0.004% are prodrugs and analogs of prostaglandin F2α. Bimatoprost 0.03% is regarded as a prostamide, and debate continues as to whether it is a prodrug. The free acids of all 3 PGAs reduce IOP by enhancing uveoscleral and trabecular outflow via direct effects on ciliary muscle relaxation and remodeling of extracellular matrix. The vast majority of clinical trials demonstrate IOP-lowering superiority of latanoprost, bimatoprost and travoprost compared with timolol 0.5%, brimonidine 0.2%, or dorzolamide 2% monotherapy. Bimatoprost appears to be more efficacious in IOP-lowering compared with latanoprost, with weighted mean difference in IOP reduction documented in one meta-analysis of 2.59% to 5.60% from 1- to 6-months study duration. PGAs reduce IOP further when used as adjunctive therapy. Fixed combinations of latanoprost, bimatoprost or travoprost formulated with timolol 0.5% and administered once daily are superior to monotherapy of its constituent parts. PGA have near absence of systemic side effects, although do have other commonly encountered ocular adverse effects. The adverse effects of PGA, and also those found more frequently with bimatoprost use include ocular hyperemia, eyelash growth, and peri-ocular pigmentary changes. Iris pigmentary change is unique to PGA treatment. Once daily administration and near absence of systemic side effects enhances tolerance and compliance. PGAs are often prescribed as first-line treatment for ocular hypertension and open-angle glaucoma.
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Affiliation(s)
- Anne J Lee
- Manchester Royal Eye Hospital, Manchester, UK
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Law SK, Kim E, Yu F, Caprioli J. Clinical cystoid macular edema after cataract surgery in glaucoma patients. J Glaucoma 2010; 19:100-4. [PMID: 20160577 DOI: m10.1097/ijg.0b013e3181a98b97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE To determine the prevalence of and risk factors for developing clinical cystoid macular edema (CME) after cataract surgery in patients with glaucoma. PATIENTS AND METHODS Medical records of patients who had cataract surgery between April 1998 and July 2006 without prior history of CME, a known risk factor to develop CME, or previous nonglaucoma ocular laser procedures or intraocular surgeries were reviewed. Clinical CME was diagnosed by fundus examination within 3 months postoperatively and confirmed with fluorescein angiography or optical coherence tomography. Outcome measures included prevalence of clinical CME by comparing patients with and without glaucoma; and risk factor analysis for clinical CME by comparing patients who did and did not develop CME after cataract surgery. RESULTS Seven hundred patients (eyes) with glaucoma and 553 patients (eyes) without glaucoma were included. The prevalences of clinical CME in glaucoma and nonglaucoma patients were 5.14% and 5.79%, respectively (P=0.618). Patients who developed clinical CME (68 patients) had statistically higher rates of posterior capsule rupture or required anterior vitrectomy during surgery (P=0.010, odds ratio=3.35, 95% CI 1.33-8.45) compared with patients who did not develop clinical CME (1185 patients). No glaucoma medications used either preoperatively or postoperatively were associated with clinical CME (P>0.05). CONCLUSIONS Rupture of posterior capsule and anterior vitrectomy during cataract surgery is a potential risk factor for developing clinical CME after cataract surgery. There is no statistically significant difference in the prevalence of clinical CME after small corneal incision phacoemulsification cataract surgery between glaucoma and nonglaucoma patients.
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Affiliation(s)
- Simon K Law
- Department of Opthalmology, Jules Stein Eye Institute, Los Angeles, California 90095, USA.
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