Prostaglandin-induced cystoid macular edema following routine cataract extraction
Negin Agange, Sameh Mosaed, Negin Agange, Sameh Mosaed
Abstract
To our knowledge, we are reporting the first case of a 59-year-old man who developed recurrent CME with three separate trials of three different prostaglandin class drugs following uncomplicated phacoemulsification with intraocular lens implantation. Despite multiple reports of individual prostaglandin (PG) analogues being suggested as the cause of CME, there are no recommendations regarding withholding these medications in the perioperative period. Our patient first developed CME OD 4-months post uncomplicated cataract extraction. XALATAN (Latanoprost) had been restarted after surgery and discontinued at onset of CME. While off XALATAN (Latanoprost), the patient's CME resolved, but his IOP rose. The patient was started on LUMIGAN (Bimatoprost) to control the IOP, but within weeks his CME recurred. The patient's CME was again treated and his IOP remained acceptable, but then progressively increased. TRAVATAN (Travoprost) was attempted, but he presented with a third round of CME. Definitive conclusions about causal relationships cannot be made without well-designed, prospective clinical trials addressing this issue.
References
- Wolter JR. The histopathology of cystoid macular edema. Graefe's Archive for Clinical and Experimental Ophthalmology. 1981;216(2):85–101.
- Weinreb RN, Kashiwagi K, Kashiwagi F, Tsukahara S, Lindsey JD. Prostaglandins increase matrix metalloproteinase release from human ciliary smooth muscle cells. Investigative Ophthalmology and Visual Science. 1997;38(13):2772–2780.
- Lindsey JD, Crowston JG, Tran A, Morris C, Weinreb RN. Direct matrix metalloproteinase enhancement of transscleral permeability. Investigative Ophthalmology and Visual Science. 2007;48(2):752–755.
- Lindsey J, Weinreb RN. Uveoscleral Outflow: Biology and Clinical Aspects. London, UK: Mosby-Wolfe Medical Communications; 1998. Effects of prostaglandins on uveoscleral outflow; pp. 41–55.
- 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. Journal of Glaucoma. 2001;10(3):233–236.
- Miyake K, Ota I, Maekubo K, Ichihashi S, Miyake S. Latanoprost accelerates disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema in early postoperative pseudophakias. Archives of Ophthalmology. 1999;117(1):34–40.
- Miyake K, Ibaraki N. Prostaglandins and cystoid macular edema. Survey of Ophthalmology. 2002;47(supplement 1):S203–S218.
- Halpern DL, Pasquale LR. Cystoid macular edema in aphakia and pseudophakia after use of prostaglandin analogs. Seminars in Ophthalmology. 2002;17(3-4):181–186.
- Lim KS, Nau CB, O’Byrne MM, et al. Mechanism of action of bimatoprost, latanoprost, and travoprost in healthy subjects. A crossover study. Ophthalmology. 2008;115(5):790–795.e4.
- Toris CB, Camras CB, Yablonski ME. Effects of PhXA41, a new prostaglandin F(2α) analog, on aqueous humor dynamics in human eyes. Ophthalmology. 1993;100(9):1297–1304.
- Toris CB, Gabelt BT, Kaufman PL. Update on the mechanism of action of topical prostaglandins for intraocular pressure reduction. Survey of Ophthalmology. 2008;53(6, supplement 1):S107–S120.
- Yeh PC, Ramanathan S. Latanoprost and clinically significant cystoid macular edema after uneventful phacoemulsification with intraocular lens implantation. Journal of Cataract and Refractive Surgery. 2002;28(10):1814–1818.
- Kraff MC, Sanders DR, Jampol LM, et al. Prophylaxis of pseudophakic cystoid macular edema with topical indomethacin. Ophthalmology. 1982;89(8):885–890.
- Wittpenn JR, Silverstein S, Heier J, Kenyon KR, Hunkeler JD, Earl M. A randomized, masked comparison of topical ketorolac 0.4% plus steroid vs steroid alone in low-risk cataract surgery patients. American Journal of Ophthalmology. 2008;146(4):554–560.
Source: PubMed