Features of drug therapy in the pre- and postoperative period in patients with glaucoma who underwent vitreoretinal intervention

Abstract

Cystoid macular edema (CME, Irwine-Gass Syndrome), despite modern methods of postoperative rehabilitation, remains an urgent problem in ophthalmology. It is most common in cataract surgery, but it also occurs with successfully performed vitreoretinal surgery. Purpose. Analysis of the causes of the development of CME and optimization of the tactics of treatment of patients with glaucoma who underwent vitreoretinal intervention. Material and methods. 6 people with CME after vitreoretinal surgery aged 69.2 ± 7.1 years were under observation at the Tri-Z clinic branch in Moscow in 2022. Vitrectomy was performed in 4 patients (66.7 %) for vitreomacular interface pathology, in two patients (33.3 %) for retinal detachment. All patients received locally prostaglandin analogues (PА) for primary open-angle glaucoma. Tactics of management of patients with glaucoma in CME: 1) cancellation of PA and replacement with therapy of similar efficacy (a combination of drugs from other groups in the absence of contraindications to their use); 2) in CME with retinal thickness up to 450 microns, Diprospan ® injection was performed parabulbar and bromfenac 0.09 % was administered locally twice a day for 2 months.; 3) with CME with a retinal thickness of more than 450 microns, dexamethasone 0.7 mg (Ozurdex®) implant was injected into the vitreal cavity and bromfenac 0.09 % was administered locally twice a day for 2 months. Results. In all patients, retinal thickness decreased from 516.2 ± 125.1 microns to 334.6 ± 62.6 microns (p< 0.05, U-criterion). After 1 month after treatment, the MVA improved from 0.41 ± 0.09 to 0.88 ± 0.11 (p< 0.05, t-criterion). Conclusions. The use of PA in patients with glaucoma may provoke CME, which requires their replacement with a combination of drugs without loss of antihypertensive efficacy. The appointment of bromfenac 0.09 % for prolonged use (up to 2 months or more) after vitreoretinal surgery reduces the risk of developing CME. The proposed tactics of management of patients with glaucoma in CME has shown its effectiveness. Keywords: cystoid macular edema, Irwine-Gass Syndrome, vitreoretinal surgery, prostaglandin analogues