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Abstract #18348 Published in IGR 3-3
Latanoprost and cystoid macular edema in high-risk aphakic or pseudophakic eyes
Wand M; Gaudio AR; Shields MBJournal of Cataract and Refractive Surgery 2001; 27: 1397-1401
PURPOSE: To determine the magnitude of the association between latanoprost use and cystoid macular edema (CME) in high-risk aphakic or pseudophakic eyes. METHODS: In a referral glaucoma practice, 40 consecutive patients with glaucoma uncontrolled on maximally tolerated medications without latanoprost were studied. Seven eyes were aphakic, and 33 pseudophakic. All eyes had an absent or open posterior capsule, and 29 had one or more additional risk factor for developing CME. Latanoprost 0.005%, one drop at bedtime, was added to the patients' current regimen. Patients were instructed to check their vision in the treated eye daily at home, and to report any perceived decrease promptly. Patients without a change in vision or other side-effects were re-examined one month after initiating latanoprost and every three months thereafter. If there was a greater than one line decrease in visual acuity, a retinal evaluation and fundus fluorescein angiography (FFA) were performed by a retina specialist. RESULTS: Two eyes had to discontinue latanoprost because of side-effects before the one-month visit. They were excluded from the analysis. At the one-month follow-up, the mean intraocular pressure was 18.2 ± 6.5 mmHg (SD), a decrease from the pretreatment mean of 21.5 ± 5.7 mmHg. Visual acuity was within one line of baseline in 36 eyes and had decreased by two lines in two eyes. In these two eyes, symptomatic CME was documented by FFA. The CME resolved clinically, with visual acuity returning to baseline after the latanoprost was discontinued and a nonsteroidal anti-inflammatory drug started. There were no additional cases of CME after a mean follow-up of 5.7 months. CONCLUSIONS: Approximately 5% of high-risk eyes treated with latanoprost developed clinically symptomatic and angiographically documented CME. The temporal relationship between initiation of treatment and the decreased vision in these two cases suggests, but does not establish, a causal relationship between CME and latanoprost. With appropriate informed consent and attentive follow-up, clinicians should not be deterred from using this important glaucoma medication.
Dr M. Wand, Consulting Ophthalmologists, 85 Seymour Street, Hartford, CN 06106, USA
Classification:
11.4 Prostaglandins (Part of: 11 Medical treatment)
