Prostaglandin Release After Low-Energy Femtosecond Laser-Assisted Cataract Surgery Without Anti-Inflammatory Drug Premedication

Luca Schwarzenbacher,Daniel Schartmüller,Christina Leydolt,Rupert Menapace

doi:10.1016/j.ajo.2022.01.002

Luca Schwarzenbacher, Daniel Schartmüller + Show 2 more

Open Access

https://doi.org/10.1016/j.ajo.2022.01.002

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Abstract

To compare prostaglandin E2 (PGE-2) levels in the aqueous and pupil diameter in patients undergoing low-pulse energy femtosecond laser-assisted cataract surgery (LCS) without non-steroidal anti-inflammatory (NSAID) pretreatment with either fragmentation or capsulotomy performed first. Prospective, randomized, fellow-eye controlled comparison. This study was undertaken at the Department of Ophthalmology, Medical University of Vienna. The population consisted of 140 eyes of 70 patients with bilateral age-related cataract. Bilateral same-day LCS with either anterior capsulotomy before lens fragmentation (Caps-First) in one eye or vice versa (Frag-First) in a random sequence were performed. Aqueous was tapped 5 minutes after LCS and PGE-2 concentration was analyzed. Pupil diameters were recorded immediately before and after femtosecond laser pretreatment. The main outcome measure was PGE-2 concentrations in picograms/milliliter and pupil diameter in millimeters. Mean PGE-2 concentrations were 42.0 ± 63.7 pg/mL in the Caps-First group versus 71.8 ± 160.7 pg/mL with the Frag-First group (P=.186). Mean pupil diameters before and after pretreatment were 7.6 ± 0.8 mm and 7.6 ± 0.8 mm, respectively (P=.871). Mean PGE-2 concentrations and pupil diameters did not show any significant difference between time points or groups. Low-energy femtosecond laser pretreatment did not increase PGE-2 levels in the absence of NSAID pretreatment. This was independent of whether capsulotomy or fragmentation was performed first. Moreover, no pupillary miosis was observed.

Highlights

High prostaglandin (PG) and cytokine concentrations have been found in the aqueous humor (AH) after pretreatment of the cataractous lens with regular femtosecond lasers (FSLs) which can be blocked by extensive non-steroidal antiinflammatory drug (NSAID) premedication.[1]
A high increase of prostaglandin (PG) concentration has been reported in the aqueous humor (AH) after regular femtosecond laser (FSL) pretreatment.[8,9,19]
When using a low pulse energy FSL only a slight elevation in inflammatory mediatorsconcentration can be seen in the aqueous. 7This increase causes intraoperative miosis and may have other negative side-effects on intraocular tissues including the blood-aqueous barrier and macula.[13]

Summary

Introduction

High prostaglandin (PG) and cytokine concentrations have been found in the aqueous humor (AH) after pretreatment of the cataractous lens with regular femtosecond lasers (FSLs) which can be blocked by extensive non-steroidal antiinflammatory drug (NSAID) premedication.[1]. The anterior capsulotomy was attributed as the main trigger and the anterior lens epithelial cells (antLEC) forming a contiguous layer on the back-side of the anterior capsule as the main source.[3,4,5,6] PGs are simultaneously released from anterior uveal tissue through shock-waves induced by the laser pulses and are known to lead to intraoperative miosis.[7,8,9] Constriction of the pupil during the femtosecond laser pretreatment is a major safety issue as successful capsulotomy and lens fragmentation rely on a stable pupil diameter with no constriction during femtosecond laser-assisted cataract surgery (LCS).[10,11,12] Cytokines may infringe the blood-aqueous barrier and dissipate into the posterior segment with potential impact on the macula.[13,14]

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