Eyeworld

20 | EYEWORLD | OCTOBER 2019 ASCRS NEWS EYEWORLD JOURNAL CLUB by Geoffrey Rodriguez, MD, Alexander Dillon, MD, Daniel Kornberg, MD, Christiana Gandy, MD, Mahmood Khan, MD, Michelle Sun, MD, Jason Chien, MD, Stephanie Engelhard, MD, Karina Somohano, MD, Grace Sun, MD Grace Sun, MD, Ophthalmology residency program director Weill Cornell Medicine Review of "Cystoid macular edema following prostaglandin analogue use after uncomplicated cataract surgery in glaucoma patients: A randomized clinical trial" estimated to be 3.54%—and the high incidence of cataract surgery, a significant number of patients undergoing cataract surgery may be on latanoprost preoperatively. 10,11 The primary outcome measure in this study was the change in central macular thickness (CMT) between preoperative and postopera- tive measurements by OCT imaging at 1 and 3 months. Secondary outcome measures includ- ed the incidence of clinical PME on fundus examination, incidence of significant increase in CMT (here defined as >50 µm) compared to baseline, visual acuity, IOP, and number of glau- coma medications at both time points. Eligible glaucoma patients in need of cat- aract surgery who were on topical latanoprost 0.005% for a minimum of 6 months alone or in combination with other topical glaucoma medications were randomized to either con- tinue or discontinue latanoprost following uncomplicated cataract surgery on postop day 1. Surgeon and outcome assessors were masked to the treatment allocation; however, patients were aware of their assigned treatment group. Following enrollment, study participants under- went complete ocular examination, including measurement of CMT by OCT at baseline as well as at 1 and 3 months postop. Data was ana- lyzed using a variety of statistical methods. A total of 156 eyes from 156 patients were included in the study. No differences were found in baseline demographics and preop data (age, sex, type of glaucoma, VA baseline, IOP baseline, central corneal thickness, med- ication baseline, CMT baseline, cup to disc ratio baseline, and mean deviation of visual field baseline) between the latanoprost group and the discontinue (DC) group. Regarding the primary outcome, the latanoprost group P seudophakic cystoid macular edema (PME) is one of the most common causes of vision loss after cataract sur- gery. 1 First described by A. Ray Irvine Jr., MD, in 1953 as a "change in the vitreous humor following cataract sur- gery," PME was further characterized by J. Donald M. Gass, MD, in 1966 using fluo- rescein angiography (FA). 2,3 While FA is consid- ered the gold standard in its diagnosis, PME can be detected by OCT or clinically as decreased visual acuity 4–6 weeks postoperatively. Recent studies evaluating clinical PME after small incision phacoemulsification report incidence rates ranging from 0.1–2.35%. 4 However, with the use of OCT imaging, the detection of PME is greater, with several studies citing incidence rates from 4–11%. 5,6 Surgical complications, including vitreous loss, iris trauma, and posterior capsule rupture, can increase the risk of developing PME. 7 Other risk factors include history of diabetic macular edema, active uveitis, and use of topical glaucoma medications. 8 In particular, the associ- ation of prostaglandin analogue (PGA) use and increased risk of PME is controversial with ex- isting literature presenting conflicting evidence. In this study, Fakhraie et al. report the results of their prospective single-masked, randomized clinical trial with parallel assign- ment, evaluating the effect of postoperative latanoprost administration on the development of PME in glaucoma patients undergoing uncomplicated cataract surgery. This study addresses an issue encountered by many oph- thalmologists, because latanoprost is one of the most commonly used medications for the treatment of primary open angle glaucoma. 9 Given the high global prevalence of open angle glaucoma—the population age 40–80 years is continued on page 22 Do topical prostaglandin analogues increase the risk of CME, and should we discontinue them prior to performing cataract surgery on glaucoma patients? I invited the Weill Cornell residents to review this new randomized study that is published in this month's JCRS. —David F. Chang, MD EyeWorld Journal Club Editor

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