The Use of Prostaglandin Analogues and Cystoid Macular Edema after Uneventful Cataract Surgery: A Systematic Review and Meta-Analysis

ABSTRACT

Purpose

To evaluate whether using prostaglandin analogues (PGAs) perioperatively is associated with an increased rate of the development of clinical or subclinical cystoid macular edema (CME) after uneventful cataract surgery.

Methods

The PubMed, Scopus, and ScienceDirect databases were searched to June 2022 for this systematic review and meta-analysis. Two authors independently screened search results. Random-effects meta-analyses were performed to calculate the overall incidence rate and odds ratio (OR). Quality of studies was assessed using the modified Newcastle-Ottawa scale. The incidences of CME for continued vs discontinued use of PGAs perioperatively, continued use of PGAs, discontinued use of PGAs, and PGA users vs non-PGA antiglaucomatous users were main outcomes.

Results

Out of 544–articles, 9 studies that met the inclusion criteria were analyzed. The continued use of PGAs was not associated with an increased risk of the development of subclinical macular edema compared with discontinued use (OR = 1.32 [95% Confidence Interval (CI) = 0.49–3.51], p = .582). The overall incidence of CME was 34% (95% CI = 0.17–0.52) for continued use of PGAs and 7% (95% CI = 0.02–0.13) for discontinued use of PGAs. Using PGAs did not increase the risk of CME’s development compared with non-PGA antiglaucomatous usage (OR = 2.29 [95% CI = 0.84–6.23], p = .103)

Conclusions

Discontinuing treatment with PGAs during the perioperative period in eyes without any known risk factors for CME has no clinically significant effect on reducing the development of postoperative CME based on the existing studies. Further, well-designed randomized controlled trials need to be performed.

KEYWORDS:

• Cataract surgery
• cystoid macular edema
• glaucoma
• Meta-analysis
• phacoemulsification
• Prostaglandin analogues

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

STATEMENT OF ETHICS

The study is exempt from Ethical Committee approval given that it is a meta-analysis of previously published data as opposed to a primary study using direct/individual patient data. This research in its entirety complies with the guidelines for human studies and should include evidence that the research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki.

DATA AVAILABILITY

All data generated or analyzed during this study are included in this article and its online supplementary material. Further inquiries can be directed to the corresponding author.

SUPPLEMENTARY MATERIAL

Supplemental data for this article can be accessed online at https://doi.org/10.1080/08820538.2023.2170716

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.