OBJECTIVE: To study the effect of latanoprost, a prostaglandin analog, on the blood-aqueous barrier and angiographic cystoid macular edema (CME) formation in early postoperative pseudophakias. PATIENTS AND METHODS: Included in the study were eyes with ocular hypertension, normal-tension glaucoma, or primary open-angle glaucoma undergoing surgery for cataract. The study consisted of a randomized double-masked trial for latanoprost and an open-label controlled trial for determining the effects of diclofenac sodium or fluorometholone eyedrop use on latanoprost or its placebo. We compared 4 groups of eyes with concurrent application of latanoprost and diclofenac (group A), latanoprost and fluorometholone (group B), latanoprost placebo and diclofenac (group C), and latanoprost placebo and fluorometholone (group D). A laser flare cell meter was used to determine the severity of blood-aqueous barrier disruption, and fluorescein angiography was performed to determine angiographic CME formation. Mean diurnal intraocular pressure differences were compared on the preoperative baseline day and in the fifth postoperative week. Latanoprost (0.005%) or its placebo was given once a day starting 2 days before surgery until the fifth postoperative week. Diclofenac or fluorometholone eyedrops were given 4 times a day before surgery on the day of surgery and 3 times a day until the fifth postoperative week. RESULTS: In group B compared with group D, the amount of flare 3 days and 1 and 2 weeks after surgery and the incidence of angiographic CME in the fifth postoperative week were significantly higher. These 2 factors were significantly higher in group B than in group A (P < .05) and in group D than in group C (P < .01). There was no significant difference in these factors between groups A and C. The intraocular pressure decline was significant in groups A and B compared with groups C and D (P < .05), but there was no significant difference between groups A and B and between groups C and D. CONCLUSIONS:Latanoprost therapy enhances disruption of the blood-aqueous barrier and increases the incidence of angiographic CME formation in early postoperative pseudophakias. Because administration of nonsteroidal eyedrops such as diclofenac seems to prevent the adverse effects of latanoprost therapy while maintaining its effect to lower intraocular pressure, we suggest their concurrent application.
RCT Entities:
OBJECTIVE: To study the effect of latanoprost, a prostaglandin analog, on the blood-aqueous barrier and angiographic cystoid macular edema (CME) formation in early postoperative pseudophakias. PATIENTS AND METHODS: Included in the study were eyes with ocular hypertension, normal-tension glaucoma, or primary open-angle glaucoma undergoing surgery for cataract. The study consisted of a randomized double-masked trial for latanoprost and an open-label controlled trial for determining the effects of diclofenac sodium or fluorometholone eyedrop use on latanoprost or its placebo. We compared 4 groups of eyes with concurrent application of latanoprost and diclofenac (group A), latanoprost and fluorometholone (group B), latanoprost placebo and diclofenac (group C), and latanoprost placebo and fluorometholone (group D). A laser flare cell meter was used to determine the severity of blood-aqueous barrier disruption, and fluorescein angiography was performed to determine angiographic CME formation. Mean diurnal intraocular pressure differences were compared on the preoperative baseline day and in the fifth postoperative week. Latanoprost (0.005%) or its placebo was given once a day starting 2 days before surgery until the fifth postoperative week. Diclofenac or fluorometholone eyedrops were given 4 times a day before surgery on the day of surgery and 3 times a day until the fifth postoperative week. RESULTS: In group B compared with group D, the amount of flare 3 days and 1 and 2 weeks after surgery and the incidence of angiographic CME in the fifth postoperative week were significantly higher. These 2 factors were significantly higher in group B than in group A (P < .05) and in group D than in group C (P < .01). There was no significant difference in these factors between groups A and C. The intraocular pressure decline was significant in groups A and B compared with groups C and D (P < .05), but there was no significant difference between groups A and B and between groups C and D. CONCLUSIONS:Latanoprost therapy enhances disruption of the blood-aqueous barrier and increases the incidence of angiographic CME formation in early postoperative pseudophakias. Because administration of nonsteroidal eyedrops such as diclofenac seems to prevent the adverse effects of latanoprost therapy while maintaining its effect to lower intraocular pressure, we suggest their concurrent application.
Authors: Richard S Hoffman; Rosa Braga-Mele; Kendall Donaldson; Geoffrey Emerick; Bonnie Henderson; Malik Kahook; Nick Mamalis; Kevin M Miller; Tony Realini; Neal H Shorstein; Richard K Stiverson; Barbara Wirostko Journal: J Cataract Refract Surg Date: 2016-09 Impact factor: 3.351