Evaluating the safety of topical prostaglandin use in the postoperative period after phacoemulsification and IOL implantation

Session Details

Session Title: PCO. Cataract Surgery Complications/Management

Session Date/Time: Tuesday 08/09/2015 | 08:00-10:30

Paper Time: 10:06

Venue: Room 1

First Author: : A.Walkden UK

Co Author(s): :    E. Sioras   J. Morarji   L. Porter              

Abstract Details

Purpose:

Since their introduction, Prostaglandin analogues (PGAs) have revolutionized the pharmacological management of glaucoma. Although their mechanism of action is not fully understood, they provide a good intraocular pressure reduction for many patients and are well tolerated due to their side effect profile. Controversy exists with regards to their safety in the post operative period after cataract surgery with reports in the literature suggesting an increased frequency of cystoid macular oedema in patients using PGAs. The aim of this study was to prospectively evaluate the safety of topical prostaglandin use in the postoperative period following cataract surgery.

Setting:

Prospective clinical study with pre and post operative OCT imaging of all patients undergoing routine surgery by the same surgeon. Royal Bolton Hospital, UK

Methods:

Ethical approval was obtained. Prospective data collection from 60 eyes of 48 consecutive patients undergoing routine phacoemulsification surgery with posterior chamber IOL insertion by the same surgeon. All patients used PGAs to control IOP for at least one year prior to surgery. This was continued throughout the perioperative period. OCT scanning was performed on the day of surgery and was repeated 2weeks post-operatively and again at 6 weeks. Patients deemed to be at risk of post-operative CMO were excluded from this study. Preoperative and post operative central retinal thickness were recorded. P<0.05 was considered statistically significant.

Results:

65% female n=38. average age 78.4 years. 42 eyes were using Latanoprost, 14 using Lumigan, 3 using Ganfort, and 1 using Saflutan. One patient (1.67%) was found to have OCT proven CMO. This was not seen clinically. Mean pre operative central retinal thickness was 257µm (SD= 33 µm. Mean post operative central retinal thickness was 268 µm (SD=30 µm). No statistically significant difference was found using paired t-test analysis.

Conclusions:

Our study is the first prospective observational study of its kind to use OCT diagnosis of CMO in patients using PGAs for POAG undergoing routine phacoemulsification and IOL insertion. Although we use a small sample size, our patient cohort provides evidence that PGAs can be used safely in the post-operative period without significantly altering the CMO rate expected following routine phacoemulsification and IOL insertion. Due to our exclusion criteria, this cohort of risk factor free patients allows us to more accurately establish the role PGAs play in CMO.

Financial Interest:

NONE