Wand M, Gaudio A R, Shields M B
Hartford Hospital, Hartford, Connecticut, USA.
J Cataract Refract Surg. 2001 Sep;27(9):1397-401. doi: 10.1016/s0886-3350(01)00770-2.
To determine the magnitude of the association between latanoprost use and cystoid macular edema (CME) in high-risk aphakic or pseudophakic eyes.
Single referral glaucoma practice.
In a referral glaucoma practice, 40 consecutive patients with glaucoma uncontrolled on maximally tolerated medications without latanoprost were studied. Seven eyes were aphakic, and 33 eyes were pseudophakic. All eyes had an absent or open posterior capsule, and 29 eyes had 1 or more additional risk factors for developing CME. Latanoprost 0.005%, 1 drop at bedtime, was added to the patients' current regimen. Patients were instructed to check their vision in the treated eye daily at home and to report any perceived decrease promptly. Patients without a change in vision or other side effects were reexamined 1 month after initiating latanoprost and every 3 months thereafter. If there was a greater than 1 line decrease in visual acuity, a retinal evaluation and fundus fluorescein angiography (FFA) were performed by a retina specialist.
Two eyes had to discontinue latanoprost because of side effects before the 1 month visit. They were excluded from the analysis. At the 1 month follow-up, the mean intraocular pressure was 18.2 mm Hg +/- 6.5 (SD), a decrease from the pretreatment mean of 21.5 +/- 5.7 mm Hg. The visual acuity was within 1 line of baseline in 36 eyes and decreased by 2 lines in 2 eyes. In these 2 eyes, symptomatic CME was documented by FFA. The CME clinically resolved, with visual acuity returning to baseline after the latanoprost was discontinued and a nonsteroidal antiinflammatory drug started. There were no additional cases of CME after a mean follow-up of 5.7 months.
Approximately 5% of high-risk eyes treated with latanoprost developed clinically symptomatic and angiographically documented CME. The temporal relationship between initiation of treatment and the decreased vision in our 2 cases suggests but does not establish a causal relationship between CME and latanoprost. With appropriate informed consent and attentive follow-up, clinicians should not be deterred from using this important glaucoma medication.
确定高危无晶状体或人工晶状体眼使用拉坦前列素与黄斑囊样水肿（CME）之间关联的程度。
单一转诊青光眼诊疗机构。
在一家转诊青光眼诊疗机构中，对40例使用最大耐受剂量药物但未使用拉坦前列素且青光眼未得到控制的连续患者进行研究。7只眼为无晶状体眼，33只眼为人工晶状体眼。所有眼睛的后囊膜缺失或开放，29只眼有1个或更多发生CME的额外危险因素。在患者当前治疗方案基础上加用0.005%拉坦前列素，每晚1滴。指导患者在家中每天检查患眼视力，并及时报告任何察觉到的视力下降情况。视力无变化或无其他副作用的患者在开始使用拉坦前列素1个月后重新检查，此后每3个月检查一次。如果视力下降超过1行，由视网膜专科医生进行视网膜评估和眼底荧光血管造影（FFA）。
2只眼在1个月复诊前因副作用不得不停用拉坦前列素。它们被排除在分析之外。在1个月随访时，平均眼压为18.2 mmHg±6.5（标准差），较治疗前平均眼压21.5±5.7 mmHg有所下降。36只眼的视力在基线1行范围内，2只眼视力下降了2行。在这2只眼中，FFA记录到有症状性CME。CME在临床上得到缓解，停用拉坦前列素并开始使用非甾体类抗炎药后视力恢复到基线水平。平均随访5.7个月后未出现其他CME病例。
使用拉坦前列素治疗的高危眼中约5%发生了临床上有症状且经血管造影记录的CME。我们2例患者治疗开始与视力下降之间的时间关系提示但未确立CME与拉坦前列素之间的因果关系。在获得适当知情同意并进行仔细随访的情况下，临床医生不应因使用这种重要的青光眼药物而受到阻碍。
