dinoprost and Macular-Edema

The author postulates that prostaglandins and other inflammatory mediators synthesized in the ocular tissues during surgery play a role in the manifestation of postsurgical cystoid macular edema (CME). Thus, topical indomethacin was used before and shortly after intracapsular lens extraction and retinal detachment surgery, and was found to reduce the incidence of postoperative CME. Radioimmunoassay measurements of prostaglandins in subjects immediately after lens extraction and also in subjects with vitreous incarceration to anterior segments and persistent CME showed substantially elevated levels of prostaglandins. These findings indicate that inflammatory mediators including prostaglandins play a role in the manifestation of postsurgical CME. The factors that make CME chronic and the rationale for using vitrectomy in persistent CME are discussed in relation to the prostaglandin theory. This review primarily covers the author's previous studies.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aqueous Humor; Cataract Extraction; Dinoprost; Drug Evaluation; Female; Humans; Indomethacin; Macular Edema; Male; Middle Aged; Ophthalmic Solutions; Prostaglandins E; Prostaglandins F; Random Allocation; Scleral Buckling; Vitrectomy

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

To report angiographically documented cystoid macula edema associated with the use of each of the three newly available ocular hypotensive lipids: unoprostone, travaprost, and bimatoprost.. Observational case series.. Retrospective review of three patients in a clinical practice who had uncontrolled glaucoma on maximal tolerable therapy except for an ocular hypotensive lipids. All three patients also had previous cataract and filtration surgery, and all had an absent or open posterior lens capsule. The patients were informed of the potential risks of cystoid macula edema associated with the use of an ocular hypotensive lipids versus the risks of repeat filtration surgery.. An ocular hypotensive lipids was started in the affected eye in each patient, and the patient was instructed to check visual acuity everyday and report back any change in vision occurred.. Decreased vision of at least two lines caused by angiographically confirmed cystoid macula edema was noted in each of three patients started, respectively, on unoprostone, travaprost, and bimatoprost. The visual acuity returned to baseline, and the cystoid macula edema was angiographically resolved after discontinuation of the ocular hypotensive lipids and the initiation of a topical steroid and non-steroidal anti-inflammatory eyedrops. Until a causal relationship between cystoid macula edema and ocular hypotensive lipids is proved or disproved, caution in their use in high-risk eyes would be prudent.

Topics: Aged; Aged, 80 and over; Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Dinoprost; Female; Fluorescein Angiography; Glaucoma; Humans; Intraocular Pressure; Lens Implantation, Intraocular; Lipids; Macular Edema; Male; Phacoemulsification; Retrospective Studies; Trabeculectomy; Travoprost; Visual Acuity

Vitreous samples were obtained from 41 eyes undergoing vitrectomy, and radioimmunoassays were performed to measure concentrations of the prostaglandins PGE2, PGF2 alpha, prostacyclin, and thromboxane. Presumably physiological levels (approximately 100 picograms/ml) were found in vitreous from eyes undergoing cataract extraction. Eyes with vitreous haemorrhage, retinal detachment, or cystoid macular oedema had similarly low levels. Vitreous prostaglandins were mildly elevated in trauma and endophthalmitis and markedly elevated in aphakic bullous keratopathy. The role prostaglandins may play in cystoid macular oedema is reviewed.

Topics: Adult; Aged; Cataract; Dinoprost; Dinoprostone; Female; Humans; Macular Edema; Male; Middle Aged; Prostaglandins; Prostaglandins E; Prostaglandins F; Retinal Detachment; Thromboxanes; Vitreous Body