Veränderung der postoperativen zentralen Makuladicke nach Kataraktoperation unter Prostaglandinanaloga-Therapie im Vergleich zu einer Kontrollgruppe

Change in postoperative central macular thickness after cataract surgery with prostaglandin analog therapy compared to a control group

by Felix Rudolph Guggenmoos-Schreyer
Doctoral thesis
Date of Examination:2019-08-13
Date of issue:2019-08-12
Advisor:Dr. Dirk Bahlmann
Referee:Prof. Dr. Hans Hoerauf
Referee:Prof. Dr. Ralph Rödel
Persistent Address: http://dx.doi.org/10.53846/goediss-7596

 

 

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Abstract

English

Introduction: The Cystoid macular edema, with an incidence of 1 to 4%, is a rare but serious complication of cataract surgery, resulting in postoperative visual acuity reductions. It is caused by inflammatory mediators, which are secreted by the intraocular surgery in the anterior part of the eye and cause a barrier disorder on the retinal vessels. This barrier disorder results in the exsudation of intravascular fluid, which accumulates in the macula, leading to an increase in macular thickness and therefore a decrease in visual acuity. Prostaglandin analogues are topical drugs used to treat glaucoma. By improving the uveoscleral outflow, the intra-ocular pressure is lowered. Because of the structural similarity to the prostaglandins secreted as inflammatory mediators in the previous sections, prostaglandin analogues are believed to increase the incidence of cystoid macular edema following cataract extraction, with many cataract surgeons discontinuing this drug during the operation for several weeks postoperatively.  Material and methods: A clinically prospective study was conducted with a test group and a control group of 20 patients each receiving prostaglandin analoga daily. Both groups underwent cataract surgery without intraoperative complications. Measurements were performed pre- and on average 42 days postoperatively. Measurement of central foveal thickness using optical coherence tomography, measurement of intraocular pressure using Goldmann applanation tonometry, and Snellen vision determination.   Results: In both groups, a significant increase in macular thickness was observed. There was no significant difference between the two groups. Cystoid macular edema did not occur in either group. In both groups there was a significant decrease in intraocular pressure and a significant increase in visual acuity. Conclusion: The result shows that the prostaglandin analogue eye drops used here have no influence on the central postoperative macular thickness during cataract surgery. This is an indication that the prostaglandin analogues do not lead to an increased postoperative risk of macular edema and therefore do not have to be discontinued pre- and postoperatively. Limitations of the study are the small patient collectiv and the limited observation period.
Keywords: Cystoid Macular edema
 
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