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J.H. Chang, P.J. McCluskey, T. Missotten, P. Ferrante, S.L. Lightman; Use of Ocular Hypotensive Prostaglandin Analogues in Patients With Uveitis: Effect on Anterior Uveitis and Cystoid Macular Edema . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2425.
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With the widespread use of prostaglandin (PG) analogues to treat raised intraocular pressure (IOP), several uncontrolled reports have described their association with the development of anterior uveitis and cystoid macular edema (CME). Although there is no good evidence for a cause–and–effect relationship, clinical uncertainty remains as to whether these drugs can be safely used in the management of raised IOP in uveitic eyes. The aim of the present study was to determine whether the use of PG analogues in the treatment of raised IOP in patients with uveitis results in an increase in anterior uveitis or clinical CME.
A retrospective case–controlled study of 84 consecutive patients (163 eyes) with uveitis and raised IOP that were treated with a PG analogue at two tertiary referral uveitis clinics, identified over a 3–month period. Control eyes were selected as those uveitic eyes of the same patients, which were treated with topical IOP–lowering agent(s) other than a PG analogue. Pre–treatment IOP was compared to the mean IOP during PG analogue treatment. The development of anterior uveitis and clinical CME during PG analogue treatment, expressed as a "rate" to account for the effects of variable follow–up, was compared to the development of these complications in the control eyes during non–PG IOP–lowering treatment.
Significant IOP reductions were observed during PG analogue treatment (P<0.05, Wilcoxon matched pairs test). There was no significant difference in the development of anterior uveitis in those eyes treated with PG analogues and those treated with non–PG agents (P>0.05, odds ratio = 0.49–1.79, Fischer’s exact test). None of the 69 uveitic eyes without a previous history of CME developed this complication. There was no association between the development of CME and treatment with a PG analogue (P>0.05, odds ratio = 0.16–1.40, Fischer’s exact test).
The present study has shown that the PG analogues can be safe and effective in the treatment of secondary ocular hypertension and glaucoma in uveitis without any appreciable increased risk of anterior uveitis or clinical CME.
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