Abstract
Abstract: :
Purpose: To investigate the effects of prostaglandin analogues on the blood–aqueous barrier and the occurrence of cystoid macular edema (CME) in aphakic or pseudophakic patients with glaucoma. Methods: Randomized, masked–observer, 6–month clinical trial. Patients with primary open angle, aphakic or pseudophakic glaucoma were treated with bimatoprost q.d. (n=16), latanoprost q.d. (n=15), travoprost q.d. (n=17), unoprostone b.i.d. (n=16), or duasorb b.i.d. (control group) (n=16). We evaluated the blood–aqueous barrier status assessed by the laser flare meter, intraocular pressure (IOP), occurrence of angiographic CME and conjunctival hyperemia. Results: Mean flare values were significantly higher in the bimatoprost, latanoprost and travoprost groups during all follow–up (p<0.019). One patient of the latanoprost group (7%) and one of the bimatoprost group (6%) had anterior uveitis detected at the slit lamp (p=0.517). Four latanoprost–treated eyes (27%), one bimatoprost–treated eye (6%), and one travoprost–treated eye (6%) developed CME. The incidence of CME was significantly higher in eyes receiving latanoprost (p=0.031). All CME cases resolved after discontinuation of the prostaglandin analogue and treatment with topical diclofenac. The mean flare values were significantly higher in patients who developed CME (30.23 ± 30.32 p/msec) compared with patients who did not present CME (11.69 ± 6.92 p/msec) (p=0.028). Mean IOP reductions after 6 months were higher for the latanoprost (26%), bimatoprost (28%), and travoprost (29%) groups than for the control (3%) and unoprostone (14%) groups (p<0.05). The IOP reduction did not differ statistically between the bimatoprost, latanoprost and travoprost groups at all time intervals (p>0.05). The bimatoprost group showed a significantly higher number of eyes (50.0%) with peak hyperemia scores > 1 than latanoprost (6.6%) (p=0.015), travoprost (11.7%) (p=0.025), unoprostone (6.2%) (p=0.015) and placebo (0%) (p=0.002). Conclusions: Bimatoprost, latanoprost and travoprost may lead to disruption of the blood–aqueous barrier in pseudophakic and aphakic patients. We recommend exercising caution when using those prostaglandin analogues in aphakic or pseudophakic patients.
Keywords: inflammation • drug toxicity/drug effects • laser