The use of prostaglandin analogues before and after phacoemulsification cataract with primary glaucoma

At present, there is no consensus on whether the use of prostaglandin analogues in the perioperative period in patients with the combination of cataract and primary open angle glaucoma (POAG) is safe, because prostaglandins are shown to be inflammatory mediators and may cause an inflammatory response or provoke the development of cystic macular edema after cataract extraction. Purpose: analysis of the impact of prostaglandin analogues in the postoperative period after cataract phacoemulsification in patients with POAG. Material and methods. We observed 58 patients with cataracts complicated by POAG who received prostaglandin analogues as hypotensives. Of these, 14 patients used them as monotherapy, 24 patients had them in combination with β-blockers and 20 patients had a combination of drugs (β-blockers and carbonic anhydrase inhibitors). Before surgery, all patients had normalized intraocular pressure (15.6 ± 0.07 mm Hg). Optical coherence tomography showed normal parameters of retinal thickness in the 1 mm area and of the macular volume in the 6-mm area, which were the same in all groups. The standard instillation pattern used after surgery lasted a week and included antibiotics, steroids, and a nonsteroidal anti-inflammatory drug (NSAID). After that, NSAIDs were administered for another 6-8 weeks, while hypotensive drugs, including prostaglandin analogues, were given throughout the entire period of observation. Results. The early postoperative period was unresponsive. The average visual acuity on the first day was 0.69 ± 0.05, and after 6-8 weeks it increased to achieve to 0.85 ± 0.05. The use of the prostaglandin analogues before and after surgery effectively prevented the development of postoperative hypertension, which was manifested in a slight rise in IOP on the first day to an average of 19.3 ± 1.1 mm Hg (monotherapy group) with an average level of IOP 16.9 ± 0.37 mm Hg in the whole group of patients. After 6-8 weeks, IOP showed no difference from the preoperative level, averaging 15.1 ± 0.28 mm Hg. The use of different groups of prostaglandin analogues did not affect the state of the retina’s macular area in the postoperative period. Conclusion. Uninterrupred use of prostaglandin analogues instillations in the pre- and postoperative period of uncomplicated phacoemulsification in patients with POAG promotes continuity in the treatment of combined pathology, maintain compliance and provide a stable IOP with no pronounced reactive hypertension // Russian ophthalmological journal. 2017; 10 (2): 28-35. (in Russian). doi: 10.21516/2072-0076-2017-10-2-28-35.

аналоги простагландинов, глаукома, факоэмульсификация, макулярный отек, профилактика, НПВС, prostaglandin analogues, primary open angle glaucoma, phacoemulsification, macular edema, prevention, nonsteroidal anti-inflammatory drugs

1. Иошин И.Э. Факоэмульсификация. Москва: Апрель; 2012.

2. Малюгин Б.Э., Шпак А.А., Морозова Т.А. Фармакологическое сопровождение современной хирургии катаракт: третье издание. Москва: Изд-во «Офтальмология». 2014.

3. Иошин И.Э., Толчинская А.И., Калинников Ю.Ю., Оздербаева А.А. Профилактика макулярного отека при факоэмульсификации катаракты. Российский офтальмологический журнал. 2014; 7 (2): 21-6.

4. Kim S.J., Flach A.J., Jampol L.M. Nonsteroidal Anti-inflammatory drugs in ophthalmology. Survey of Ophthalmology. 2010; 55 (2): 108-33.

5. Flach A.J. Nonsteroidal anti-inflammatory drugs. In: Tasman W., ed. Duanes Foundations of Clinical Ophthalmology. Philadelphia, PA., Lippincott. 1994; 2:1-32.

6. Lipter M. НПВС в профилактике кистозного макулярного отека. Eye World. 2003; 6(1):12.

7. Walters M., Raizman P., Ernest J., et al. In vivo pharmacokinetics and in vitro pharmacodynamics of nepafenac, amfenac, ketorolac, and bromfenac. J. Cataract Refract Surg. 2007; 33 (9): 1539-45.

8. Нестеров А.П. Глаукома: основные проблемы, новые возможности. Вестник офтальмологии. 2008; 1: 3-5.

9. Егоров Е.А. Гипотензивное лечение глаукомы. Клиническая офтальмология. 2000;1 (1): 6-10.

10. Егорова Т.Е. Простагландины в лечении глаукомы. Клиническая офтальмология. 2004; 3 (5): 127-32.

11. Алексеев В.Н., Левко М.А., Муса Аль-Гифари. Сравнительная оценка эффективности применения простагландинов в комбинированной терапии первичной глаукомы. Глаукома. 2009; 1: 44-8.

12. Земцова Н.А., Дмитриева Е.А. Аналоги простагландинов в современном лечении первичной открытоугольной глаукомы. Офтальмология в Беларуси. 2009; 3 (03): 41-6.

13. Shrivastava A. Prostaglandin Analogs and Cataract Surgery. J. Cataract & Refractive Surgery Today. 2008; July: 75-7.

14. Biro Z., Balla Z., Kovacs B. Change of foveal and perifoveal thickness ensured by OCT after phacoemulsification and IOL implantation. Eye (Lond). 2008; 22 (1): 8-12.

15. Agange N., Mosaed S. Prostaglandin cystoid macular edema following routine cataract extraction. J Ophthalmol. 2010; 690707. Published online 2010. November 7.

16. Miyake K., Ibaraki N. Prostaglandins and cystoid macular edema. Survey of Ophthalmology. 2002; 117 (Suppl. 1): 203-18.

17. Furuichi M., Chiba T., Abe K., et al. Cystoid macular edema associated with topical latanoprost in glaucomatous eyes with a normally functioning blood-ocular barrier. J. of Glaucoma. 2001; 3 (10): 233-6.

18. Alm A., Grierson I., Shields M.B. Side effects associated with prostaglandin analog therapy. Surv Ophthalmol. 2008; 53. Suppl 1: 93-105.

19. Law S.K., Kim E., Yu F., et al. Clinical cystoid macular edema after cataract surgery in glaucoma patients. J. Glaucoma. 2010; 2 (19): 100-4.

20. Астахов С.Ю., Астахов Ю.С., Гобеджишвили М.В. Влияние лечения аналогами простагландинов на толщину сетчатки после факоэмульсификации с имплантацией интраокулярной линзы у больных первичной открытоугольной глаукомой. Офтальмологические ведомости. 2014; 3 (7): 73-6.

21. Алексеев И.Б., Самойленко А.И., Адлейба О.А. и др. Влияние аналогов простагландинов на результаты факоэмульсификации катаракты у больных первичной открытоугольной глаукомой. Российский офтальмологический журнал. 2012; 5 (2): 4-7.

22. Басинский С.Н., Басинский А.С., Серегина С.С. Влияние аналогов простагландинов на течение послеоперационного периода у больных глаукомой после факоэмульсификации катаракты. РМЖ. Клиническая офтальмология. 2014; 2: 69-70.

23. Lavin M.J., Wormald R.P., Migdal C.S., et al. The influence of prior therapy on the success of trabeculectomy. Arch. Ophthalmol. 1990; 11 (108): 1543-8.

24. Miyake K., Ibaraki N., Goto Y., et al. ESCRS Binkhorst Lecture 2002. Pseudophakic preservative maculopathy. J. Cataract Refract. Surg. 2003; 9 (29): 1800-10.

25. Solomon L.D. Efficacy of topical flurbiprofen end endomethacin in preventing pseudophakic cystoid macular edema. Flurbiprofen - CME Study Group I. J. Cataract Refract Surg. 1995; 33 (1): 73-81.

26. Toris C.B., Gabelt B.T., Kaufman P.L. Update on the mechanism of action of topical prostaglandins for intraocular pressure reduction. Survey Ophthalmol., 2008; 6 (53): 107-20.

27. Broadway D.C., Grierson I., O'Brien C., et al. Adverse effects of topical antiglaucoma medication. I. The conjunctival cell profile. Arch. Ophthalmol. 1994; 11 (112): 1437-45.

28. Лебедев О.И., Яворский А.Е., Калужникова Е.А., Ковалевский В.В. Бензалкония хлорид как одна из причин недостаточной эффективности антиглаукоматозных операций. Российская офтальмология онлайн. 2012; 2: 48-52.