Применение аналогов простагландинов до и после факоэмульсификации катаракты на фоне первичной глаукомы

Abstract

At present, there is no consensus on whether the use of prostaglandin analogues in the perioperative period in patients with the combination of cataract and primary open angle glaucoma (POAG) is safe, because prostaglandins are shown to be inflammatory mediators and may cause an inflammatory response or provoke the development of cystic macular edema after cataract extraction. Purpose: analysis of the impact of prostaglandin analogues in the postoperative period after cataract phacoemulsification in patients with POAG. Material and methods. We observed 58 patients with cataracts complicated by POAG who received prostaglandin analogues as hypotensives. Of these, 14 patients used them as monotherapy, 24 patients had them in combination with β-blockers and 20 patients had a combination of drugs (β-blockers and carbonic anhydrase inhibitors). Before surgery, all patients had normalized intraocular pressure (15.6 ± 0.07 mm Hg). Optical coherence tomography showed normal parameters of retinal thickness in the 1 mm area and of the macular volume in the 6-mm area, which were the same in all groups. The standard instillation pattern used after surgery lasted a week and included antibiotics, steroids, and a nonsteroidal anti-inflammatory drug (NSAID). After that, NSAIDs were administered for another 6-8 weeks, while hypotensive drugs, including prostaglandin analogues, were given throughout the entire period of observation. Results. The early postoperative period was unresponsive. The average visual acuity on the first day was 0.69 ± 0.05, and after 6-8 weeks it increased to achieve to 0.85 ± 0.05. The use of the prostaglandin analogues before and after surgery effectively prevented the development of postoperative hypertension, which was manifested in a slight rise in IOP on the first day to an average of 19.3 ± 1.1 mm Hg (monotherapy group) with an average level of IOP 16.9 ± 0.37 mm Hg in the whole group of patients. After 6-8 weeks, IOP showed no difference from the preoperative level, averaging 15.1 ± 0.28 mm Hg. The use of different groups of prostaglandin analogues did not affect the state of the retina’s macular area in the postoperative period. Conclusion. Uninterrupred use of prostaglandin analogues instillations in the pre- and postoperative period of uncomplicated phacoemulsification in patients with POAG promotes continuity in the treatment of combined pathology, maintain compliance and provide a stable IOP with no pronounced reactive hypertension // Russian ophthalmological journal. 2017; 10 (2): 28-35. (in Russian). doi: 10.21516/2072-0076-2017-10-2-28-35.