Survey of perioperative prostaglandin analogue administration during cataract surgery in Greece

Abstract

Fifteen years after the introduction of the first prostaglandin analogue eye drop (PAE) as a topical intraocular pressure-lowering medication, the literature regarding PAE perioperative use in cataract surgery and potential harmful effects for the patient remains controversial. Anecdotal reports as well as case series have associated its preoperative or continued postoperative use with the occurrence of cystoid macular oedema (CMO) [1–3], while other authors only report this as a rare phenomenon and the causative relationship is debated [4, 5]. Neither the recently updated Royal College of Ophthalmologists ‘Cataract Surgery Guidelines’ (September 2010) nor the latest printing of the American Academy of Ophthalmology Preferred Practice Pattern ‘Cataract in the Adult Eye’ in 2006 provide any guidance with regards to perioperatively withholding PAE or not. We aimed to assess the current preferences of Greek surgeons on this matter and discuss their approach. A random sample of 100 members of the Greek Society of Cataract and Refractive Surgeons was selected using a computerised random number generator and were then contacted by telephone. The questions asked were: (i) Do you stop PAE when you undertake cataract surgery, and if yes, (ii) routinely or under what circumstances, and (iii) how long for before and after the operation. Responses were recorded anonymously and analysed by a blinded evaluator. Eighty-two of the 100 surgeons who were telephoned confirmed being active cataract surgeons and agreed to answer the questionnaire. Sixty-five (65/82; 80 %) replied that they discontinue PAE perioperatively, of whom fifty-three (53/82; 65 %) do so routinely. One-third of all responders (27/82; 33 %) discontinue PAE for a month postoperatively, while 15 % (12/82) do so for a variable time depending on perioperative complications or the individual circumstances of the case. Twenty-eight percent (23/82) additionally discontinue PAE treatment preoperatively from 1 to 30 days (Fig. 1). A mean complication rate of 1.5 % for clinically detectable CMO following cataract extraction with intraocular lens implantation has been reported [6] and, to date, it has not been investigated if this rate increases when using perioperative PAE. CMO has been causally associated with topical PAE treatment in different circumstances: phakic, aphakic and pseudophakic eyes [2], or with intact or ruptured posterior capsule [1–3]; hence the aetiopathogenic mechanism is hypothesised but not yet fully elucidated. It appears that some eyes present an increased susceptibility to develop CMO, possibly associated with pre-existing abnormalities of the blood–retinal barrier [1, 2]. A. Mataftsi (&) K. T. Tsaousis I. T. Tsinopoulos S. A. Dimitrakos II Department of Ophthalmology, General Hospital of ‘‘Papageorgiou’’, Aristotle University of Thessaloniki, Periferiaki Odos Thessalonikis, N. Efkarpia, 56403 Thessaloniki, Greece e-mail: mataftsi@doctors.org.uk