Avoiding cystoid macular edema in cataract surgery: the role of application time of anti-inflamatory drugs under pharmacological aspects

Poster Details

First Author: A.Parasta GERMANY

Co Author(s):                  

Abstract Details

Purpose:

The arachidonic acid cascade plays an important role in post-operative inflammation. The increase of prostaglandine release due to surgical trauma leads to rupture of blood-aqueous and blood-retinal-barriers. This is a brief overview on the pathway of inflammation in anterior and posterior segment after cataract surgery and as a result a possible timeline for preventive pharmatherapy.

Setting:

Surgical trauma on the cell membrane leads to higher activity of phosolipidase A2 (PLA2), and to higher levels of arachidonic acid in aqueous. COX1 and COX2 metabolize arachidonic acid to prostaglandines (PG). Flare, cells, and cystoid macular edema are results of activation of PG mediated inflammation cascade.

Methods:

Corticosteroids inhibit PLA2 and thus the release of arachidonic acid which leads to PG increase. NSAIDs interfere with COX1 and COX2 and inhibit the synthesis of prostaglandins. The highest activity of PLA2 is during the first hours after trauma. The effect of corticosteroids on PG release is faster than the effect of NSAID on PG synthesis.

Results:

The aim of pharmatherapy should be to prevent PG synthesis first and to avoid arachidonic acid release after surgical trauma. The fast effect of corticosteroids in PLA2 inhibition is mostly effective in the period of surgical trauma and the first hours afterwards. The inhibition of PG synthesis with NSIAD should be started before the release of phospholipids during surgery. NSIAD can achieve effective vitreous and retinal concentrations within hours before operation. (e.g. 3 h by Bromfenac BID).

Conclusions:

Perioperative and postoperative application of NSAID like Bromefenac or Ketorolac can block the PG synthesis effectively. A single application of steroids such as dexamethasone ointment immediately after operation avoids the release of arachidonic acid. Periocular injection of retarded corticosteroids like Triamcinolone could be an additional protection in CME risk individuals such as diabetic patients. FINANCIAL DISCLOSURE?: No