R 249
The effect of anti-glaucoma eyedrops on the blood-aqueous barrier disruption and the incidence cystoid macular edema in early postoperative pseudophakiasK. Miyake
Objective: To investigate the effects of preservative timolol maleate and latanoprost and their preservative and non-preservative vehicles on the blood-aqueous barrier and angiographic cystoid macular edema (CME) in early postoperative pseudophakias.
Patients and Methods: The subjects in the present study were patients with ocular hypertension, normal tension glaucoma, and primary open angle glaucoma who underwent surgery for cataracts. The study included a double-masked trial for timolol and vehicles with and without the preservative, benzalkonium chloride, and also for latanoprost and its non-preservative vehicle, and a single-masked trial on the effect of diclofenac sodium and fluorometholone. The above groups were compared using a laser flare cell meter to determine the degree of disruption of the blood-aqueous barrier and fluorescein angiography to investigate angiographic CME. The differences in mean daily fluctuations in intraocular pressure were compared on the preoperative baseline day and for 5 weeks postoperatively.
Results and Conclusion: Timolol, latanoprost, and their preservatives benzalkonium chloride all cause disruption of the blood-aqueous barrier in early postoperative pseudophakias and an increased incidence of angiographic CME. The concurrent administration of nonsteroidal anti-inflammatory drug such as diclofenac prevents these adverse effects without interfering with the drop in intraocular pressure caused by these anti-glaucoma eyedrops. The present study suggests that the addition of benzalkonium chloride to anti-glaucoma eyedrops contributes to these side effects, at least in considerable part.
Clinical Relevance: The present findings indicate the importance of considering the cause of similar complications produced by anti-glaucoma eyedrops (epinephrine maculopathy is well-known in old days) containing similar preservatives, and taking measures to prevent them. One may name this complication as "preservative maculopathy."
Miyake Eye Hospital, Kita-ku Nagoya, Japan