bimatoprost and Pseudophakia

To investigate the effects of prostaglandin analogues on the blood-aqueous barrier and to evaluate the occurrence of cystoid macular edema in aphakic or pseudophakic patients with glaucoma.. In this randomized, masked-observer, 6-month clinical trial, patients with primary open-angle, pseudophakic, or aphakic glaucoma were treated once daily with bimatoprost (n = 16), latanoprost (n = 15), or travoprost (n = 17) or twice daily with unoprostone (n = 16) or lubricant drops (control group) (n = 16). Blood-aqueous barrier status, which was assessed using a laser flare meter; intraocular pressure; the occurrence of angiographic cystoid macular edema; and conjunctival hyperemia were evaluated.. Mean flare values were significantly higher in the bimatoprost, latanoprost, and travoprost groups throughout follow-up (P < .02). Four latanoprost-treated eyes, 1 bimatoprost-treated eye, and 1 travoprost-treated eye developed cystoid macular edema; all cases resolved after discontinuation of the prostaglandin analogue and treatment with topical diclofenac sodium. Mean intraocular pressure 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< .05). Bimatoprost induced significantly higher hyperemia scores than latanoprost, unoprostone, and placebo (P< .01).. Bimatoprost, latanoprost, and travoprost use may lead to disruption of the blood-aqueous barrier in patients with pseudophakia and aphakia.

Topics: Aged; Amides; Antihypertensive Agents; Aphakia, Postcataract; Bimatoprost; Blood-Aqueous Barrier; Cloprostenol; Dinoprost; Female; Fluorescein Angiography; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Latanoprost; Lipids; Macular Edema; Male; Middle Aged; Prospective Studies; Prostaglandins F, Synthetic; Pseudophakia; Safety; Travoprost

The purpose of this article is to determine the association of postoperative topical prostaglandin analog (PGA) or topical beta-blocker use and the incidence of pseudophakic cystoid macular edema (CME).. This was a nested case-control study. All adult patients who underwent cataract surgery between January 1, 2006 and December 31, 2016 and who were enrolled in the PharMetrics Plus database were eligible for inclusion. The association between postoperative topical PGAs (bimatoprost, latanoprost, and travoprost/travoprost-z) or beta-blocker (betaxolol, levobunolol, and timolol) use and the incidence of pseudophakic CME was assessed by conditional logistic regression.. Five hundred eight cases and 5080 controls were included in the analyses. Incidence of pseudophakic CME was found to be statistically significantly associated with the current postoperative use of both topical PGAs [relative risk (RR), 1.86; 95% confidence interval (CI), 1.04-3.32] and topical beta-blockers (RR, 2.64; 95% CI, 1.08-6.49). Postoperative use of each of bimatoprost (RR, 2.73; 95% CI, 1.35%-5.53%) and travoprost/travoprost-z (RR, 3.16; 95% CI, 1.42-7.03) in the year before diagnosis was demonstrated to be statistically significantly associated with the incidence of pseudophakic CME. This association was not observed to be statistically significant with the postoperative use of latanoprost (RR, 1.55; 95% CI, 0.84-2.88).. To the best of our knowledge this is the largest study that has investigated the association between postoperative topical PGA or topical beta-blocker use and the incidence of pseudophakic CME. Postoperative use of both topical PGAs and topical beta-blockers was found to be associated with the incidence of pseudophakic CME.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Aged, 80 and over; Bimatoprost; Case-Control Studies; Cataract; Cataract Extraction; Combined Modality Therapy; Female; Humans; Incidence; Intraocular Pressure; Latanoprost; Macular Edema; Male; Middle Aged; Postoperative Complications; Postoperative Period; Prostaglandins, Synthetic; Pseudophakia; Timolol; Travoprost

Prostaglandin-like drugs such as latanoprost (Xalatan), travoprost (Travatan) and bimatoprost (Lumigan) lower the intraocular pressure by improving the outflow of aqueous humor via the uveoscleral pathway. Up to now there is no report about a macular edema after the topical use of Lumigan eye drops in a pseudophakic patient with an intact posterior capsule.. A 69-year-old pseudophakic patient with a 14-year history of glaucoma in pseudoexfoliation syndrome, revealed a cystoid macular edema after local treatment with bimatoprost . 6 months earlier a phakoemulsification followed by the insertion of a posterior intraocular lens was performed on the left eye. Due to an elevated intraocular pressure after the surgery, which could not be controlled either by several eyedrops, or by three more operations (one viscocanalostomy with mitomycin c, two cyclophotocoagulations), therefore, a final attempt with bimatoprost (Lumigan) was started. Two weeks later the patient complained of blurred vision, caused by a cystoid macular edema.. After discontinuation of bimatoprost and initiation of a local and systemic anti-inflammatory therapy, the edema resolved and visual acuity recovered.. Bimatoprost (Lumigan) , a synthetic prostamid is similar to human prostaglandins, especially to prostaglandin F (2alpha.) Although it does not bind to the same receptor, its side effects are comparable to those of common prostaglandin analogues. So far there are no reports about the manifestation of a macular edema after using bimatoprost in pseudophakic eyes with an intact posterior capsule. Even if three more operations followed the cataract surgery, we suspect that bimatoprost eyedrops can be held responsible for this. Therefore they should be used with great care and in clear indications, particularly in pseudophakic patients.

Topics: Administration, Topical; Aged; Amides; Bimatoprost; Cloprostenol; Glaucoma; Humans; Lipids; Macular Edema; Male; Pseudophakia

To report a case of angiographically documented cystoid macula edema occurring after switching a pseudophakic patient from latanoprost to bimatoprost.. Observational case report.. A 68-year-old man developed intense conjunctival hyperemia and cystoid macula edema after switching from latanoprost to bimatoprost 9 months after cataract surgery in an eye at low-risk for this cystoid macular edema.. Bimatoprost was discontinued and diclofenac initiated. After 2 months, visual acuity and ocular hyperemia returned to baseline levels. Fundus examination revealed resolution of cystoid macula edema.. It is possible that pseudophakic eyes that develop intense conjunctival hyperemia associated with ocular hypotensive lipids might be at higher risk for developing cystoid macula edema.

Topics: Aged; Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Conjunctiva; Fluorescein Angiography; Glaucoma, Open-Angle; Humans; Hyperemia; Intraocular Pressure; Latanoprost; Lipids; Macular Edema; Male; Prostaglandins F, Synthetic; Pseudophakia; Risk Factors