Zhou Yujia, Bicket Amanda K, Marwah Shikha, Stein Joshua D, Kishor Krishna S
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida.
Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
Ophthalmol Glaucoma. 2025 Jan-Feb;8(1):4-11. doi: 10.1016/j.ogla.2024.07.010. Epub 2024 Aug 8.
There is a longstanding belief that prostaglandin analogs (PGAs) may predispose patients with glaucoma to develop acute cystoid macular edema (CME). However, there is little solid evidence supporting this notion. The purpose of this study is to compare CME incidence rates among patients initiating treatment with different glaucoma medication classes.
Database study.
A total of 39 948 patients who were newly prescribed glaucoma medications METHODS: Using data from 10 health systems contributing data to the Sight Outcomes Research Collaborative Ophthalmology Data Repository, we identified all adults with glaucoma who had been newly started on a topical glaucoma medication. Patients with pre-existing documentation of macular edema were excluded. We assessed the incidence of CME among patients with glaucoma who were newly started on PGAs, topical beta blockers (BBs), alpha agonists (AAs), and carbonic anhydrase inhibitors (CAIs). Using multivariable logistic regression, and adjusting for sociodemographic factors, we assessed the odds of developing CME among patients prescribed each of the 4 glaucoma medication classes. We also performed a subset regression analysis including lens status as a covariate.
Incidence of CME within 3 months of initiating therapy with different topical glaucoma medications.
Among the 39 948 patients who were newly treated with a topical glaucoma medication, 139 (0.35%) developed CME. The incidence of CME was 0.13%, 0.65%, 0.55%, and 1.76% for users of PGAs, BBs, AAs, and CAIs, respectively. After adjusting for sociodemographic factors, users of topical BBs, AAs, and CAIs had substantially higher odds of developing CME compared with PGA users (P < 0.001 for all comparisons). The subset analysis also showed higher odds ratio of the non-PGA medication classes in association with CME.
Clinicians should reconsider the notion that PGAs carry a higher risk of CME versus other glaucoma medication classes. If additional studies support the findings of these analyses, clinicians may feel more comfortable prescribing PGAs to patients with glaucoma without fear they will predispose patients to CME.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
长期以来，人们一直认为前列腺素类似物（PGA）可能使青光眼患者更容易发生急性黄斑囊样水肿（CME）。然而，几乎没有确凿证据支持这一观点。本研究的目的是比较开始使用不同类别青光眼药物治疗的患者中CME的发生率。
数据库研究。
共有39948例新开具青光眼药物的患者
利用来自10个卫生系统的数据，这些数据被纳入视力结果研究协作眼科数据存储库，我们确定了所有新开始使用局部青光眼药物的青光眼成年患者。排除已有黄斑水肿记录的患者。我们评估了新开始使用PGA、局部β受体阻滞剂（BB）、α受体激动剂（AA）和碳酸酐酶抑制剂（CAI）的青光眼患者中CME的发生率。使用多变量逻辑回归，并对社会人口统计学因素进行调整，我们评估了开具这4种青光眼药物类别的患者中发生CME的几率。我们还进行了一项亚组回归分析，将晶状体状态作为协变量。
开始使用不同局部青光眼药物治疗后3个月内CME的发生率。
在39948例新接受局部青光眼药物治疗的患者中，139例（0.35%）发生了CME。使用PGA、BB、AA和CAI的患者中CME的发生率分别为0.13%、0.65%、0.55%和1.76%。在对社会人口统计学因素进行调整后，与使用PGA的患者相比，使用局部BB、AA和CAI的患者发生CME的几率显著更高（所有比较P<0.001）。亚组分析还显示，非PGA药物类别与CME相关的优势比更高。
临床医生应重新考虑PGA与其他青光眼药物类别相比发生CME风险更高的观点。如果更多研究支持这些分析结果，临床医生在给青光眼患者开PGA时可能会更放心，不用担心会使患者易患CME。
在本文末尾的脚注和披露中可能会发现专有或商业披露信息。
