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Vision effects of latanoprost post-cataract are minimal, study shows
Once latanoprost is discontinued, visual acuity is restored. When used in conjunction with an NSAID, latanoprost side effects are diminished while IOP is controlled.
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FORT LAUDERDALE, Fla. — Out of 185 patients receiving latanoprost (Xalatan; Pharmacia & Upjohn) for glaucoma sometime after cataract surgery, only four patients experienced reduction in vision. Three of these four had cystoid macular edema (CME) and one had progression of glaucoma. This is according to a study conducted by Sarwat Salim, MD, and M. Bruce Shields, MD, of Yale University School of Medicine. Dr. Salim presented results of the study at the annual meeting of the Association for Research in Vision and Ophthalmology here.
According to Dr. Salim, many case reports have shown an association between the incidence of CME and the use of latanoprost. The purpose for conducting this study was to determine if the occurrence of CME was higher in complicated cataract patients who postoperatively received latanoprost to control IOP.
Dr. Salim said if there is any association between latanoprost and CME, the incidence within the study’s timeframe appeared to be significantly low. CME occurred in only three high-risk patients who experienced ruptured posterior capsules at the time of cataract removal.
“Overall, the incidence of CME with latanoprost seems to be uncommon,” Dr. Salim told Ocular Surgery News. “But if you look at a high risk population, such as the patients who had complicated cataract surgery, the incidence seems to be higher.”
In a separate study evaluating latano-prost use in conjunction with non-steroidal eye drops, latanoprost successfully lowered intraocular pressure (IOP) while side effects were minimized.
The CME-latanoprost relationship
Latanoprost has been associated with the disruption of the blood-aqueous barrier, according to some studies. “We are not saying you can’t use latanoprost [after complicated cataract surgery],” Dr. Salim said. “You just have to be careful, and you need to follow your patients a lot more closely and advise them that if they experience a decrease in visual acuity, they should return to their physician.”
According to the study, in patients who noticed a decrease in visual acuity, their vision returned when latanoprost therapy was discontinued. The CME in these patients was not related to the cataract surgery itself, according to Dr. Salim, since no decrease in vision was witnessed until after latanoprost was administered.
Latanoprost with nonsteroidals
In a complementary study by Miyake, the outcomes of latanoprost were measured based on their effect on the blood-aqueous barrier and the incidence of CME in postoperative pseudophakia. The study suggests that latanoprost therapy enhances disruption of the blood-aqueous barrier and increases the frequency of angiographic CME in early postoperative pseudophakia. Prosta-glandins, according to the authors, are believed to play a role as inflammatory mediators; however, latanoprost differs from endogenous prostaglandins.
This study evaluated the effects of latano-prost administration on the blood-ocular barrier in diseased eyes with abnormal activity and transport of endogenous prostaglandins. In this randomized double-masked trial, some patients also received nonsteroidal eye drops, such as diclofenac, which helped to prevent the adverse effects of latanoprost while maintaining its effect of lowering IOP. The authors concluded that the ad-verse effects associated with latanoprost could be prevented if nonsteroidal eye drops are given concurrently.
The authors reported that latanoprost use never was described as inducing disruption of the blood-aqueous and blood-retinal barriers in animal or human eyes or resulting in CME in longstanding pseudophakias. Miyake reported that recent studies, both in vivo and in vitro, demonstrated that in eyes distressed by surgery, the lens epithelial cells proliferate and transform, and various chemical mediators are created. This changing process of the epithelial cells is believed to possibly modify postoperative inflammation, resulting in pupillary fibrin membrane development. This synthesis, according to the authors, explains the elevation in the amount of aqueous flare 1 to 2 weeks postoperatively but not immediately following surgery. Aqueous flare was the same 1 day after surgery in the latanoprost patients and in patients receiving placebo, but was increased 3 days and 1 and 2 weeks postoperatively in eyes receiving latanoprost and fluorometholone, as well as in eyes receiving fluorometholone and placebo.
According to the authors, latanoprost, an external prostaglandin F2a, is not the mediator that disrupts the blood-aqueous barrier. If that was the case, the disruption 1 day following surgery should be more severe in eyes receiving latanoprost. Additionally, the authors discovered that the blood-aqueous barrier disruption was prevented equally in the placebo plus nonsteroidal group as it was in the latanoprost group that also was receiving nonsteroidal eye drops. This confirms that there may not be any direct relationship between latanoprost therapy and disruption of the blood-aqueous barrier and supports recent findings from studies reporting that latanoprost has only a minimum effect, if any, on blood-aqueous barrier function. Also, an increase in angiographic CME was encountered in eyes receiving latanoprost shortly after cataract surgery, but this also was prevented with concurrent use of nonsteroidal eye drops.
For Your Information:Reference:
- Sarwat Salim, MD, and M. Bruce Shields, MD, can be reached at Yale University School of Medicine–Ophthalmology and Vision Science, 330 Cedar St., P.O. Box 208061, New Haven, CT 06520-8061; (203) 785-7233; fax: (203) 785-7694 or (718) 438-0270. Dr. Salim has no direct financial interest in any of the products mentioned in this article, nor is she a paid consultant for any companies mentioned.
- 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. Arch Ophthalmol. 1999;117:34-40.