Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.
Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland.
Acta Ophthalmol. 2019 Mar;97(2):178-184. doi: 10.1111/aos.13911. Epub 2018 Sep 5.
To examine the role of systemic medication on the risk of pseudophakic cystoid macular edema (PCME) following uneventful cataract surgery.
A total of 269 eyes undergoing routine cataract surgery. Spectral-domain optical coherence tomography imaging was conducted before surgery and at 28 days. Information about medication of the participants was gathered from The National Archive of Health Information (Kanta), an electronic pharmaceutical database.
Systemic medication with angiotensin converting enzyme inhibitor/angiotensin II receptor antagonists (p < 0.001), beta-blockers (β-blockers) (p = 0.002), calcium channel blockers (CCBs) (p < 0.001), nitrates (p =0.021) and lipophilic HMG-CoA reductase inhibitors (statins) (p < 0.001) were more frequently prescribed to diabetic compared with nondiabetic patients. In eyes with steroid monotherapy (N = 135), concomitant systemic medication with β-blockers (12.9 ± 24.0 μm versus 28.6 ± 59.5 μm, p = 0.045), CCBs (12.0 ± 22.1 μm versus 26.3 ± 55.6 μm, p = 0.041) and statins (12.9 ± 22.8 μm versus 30.0 ± 61.9 μm, p = 0.038) attenuated a change in central retinal thickness (CRT) when compared to patients not receiving medication. In multivariable analysis, the use of CCBs remained as an independent protective factor against macular swelling at 28 days (-0.23; 95% CI [-0.43 to -0.04]; p = 0.021), when all systemic medications showing statistical significance were included (i.e. β-blockers, CCBs and statins) together with diabetes status. In eyes with nonsteroidal anti-inflammatory drug (NSAID) monotherapy (N = 67) and steroid and NSAID combination therapy (N = 67), CRT increase was moderate both with and without use of systemic medications.
Systemic vasoactive medication may be protective against CRT change induced by cataract surgery in eyes at risk of PCME such as those with postoperative steroid monotherapy.
研究白内障术后无并发症情况下，全身药物治疗对视神经上皮下囊样水肿（PCME）发生风险的作用。
对 269 例接受常规白内障手术的患者进行研究。所有患者术前和术后 28 天均进行频域光学相干断层扫描（OCT）成像。从国家健康信息档案（Kanta），一个电子药物数据库中收集参与者的药物信息。
与非糖尿病患者相比，患有糖尿病的患者更常接受血管紧张素转换酶抑制剂/血管紧张素 II 受体拮抗剂（ACEI/ARB）（p < 0.001）、β-受体阻滞剂（β-blockers）（p = 0.002）、钙通道阻滞剂（CCB）（p < 0.001）、硝酸盐（p = 0.021）和脂溶性 HMG-CoA 还原酶抑制剂（他汀类药物）（p < 0.001）等全身药物治疗。在接受皮质类固醇单药治疗的患者（N = 135）中，与未接受药物治疗的患者相比，同时接受β-受体阻滞剂（12.9 ± 24.0 μm 与 28.6 ± 59.5 μm，p = 0.045）、CCB（12.0 ± 22.1 μm 与 26.3 ± 55.6 μm，p = 0.041）和他汀类药物（12.9 ± 22.8 μm 与 30.0 ± 61.9 μm，p = 0.038）治疗的患者，中心视网膜厚度（CRT）的变化更小。多变量分析显示，当包括所有具有统计学意义的全身药物（即β-受体阻滞剂、CCB 和他汀类药物）以及糖尿病状态时，CCB 的使用仍然是 28 天黄斑肿胀的独立保护因素（-0.23；95%CI [-0.43 至-0.04]；p = 0.021）。在接受非甾体抗炎药（NSAID）单药治疗（N = 67）和皮质类固醇和 NSAID 联合治疗（N = 67）的患者中，无论是否使用全身药物，CRT 均有中度增加。
全身血管活性药物可能对接受白内障手术后有发生 PCME 风险的患者（如术后接受皮质类固醇单药治疗的患者）的 CRT 变化具有保护作用。
