Effectiveness and Safety of Cataract Surgery Pharmacological Support in Glaucoma Patients

Purpose: To evaluate effectiveness and safety of cataract surgery pharmacological support (which include 0.5 % levofloxacin, 0.09 % bromfenac and preservative free polyvinylpyrrolidone and polyvinyl alcohol fixed combination instillations) in glaucoma patients. Patients and Methods: Standard ophthalmological examination, subjective discomfort level evaluation, tear film break up time, tear meniscus height measurement, index of xerosis, evaluation and ocular surface condition photoregistration were performed in 40 II «A» primary open-angle glaucoma patients, receiving hypotensive therapy, before and after phacoemulsification (Ph). All patients in the postoperative period received instillations: 0.5 % levofloxacin (4 times a day, 7 days), 0.1 % dexamethasone (3 times a day, 7 days), 0.09 % bromfenac (once a day, 30 days) and preservative free polyvinylpyrrolidone and polyvinyl alcohol fixed combination (3 times a day, 30 days). Control points were: examination before Ph, on 1, 7 and 30 days after Ph. Results: None cases of infectious or inflammatory surgery complications were recorded. The SD level was significantly increased on the 1 and 7 days after Ph, by the 30 day the SD level was significantly decreased, compared with a state on the 1 and 7 days. On the 1, 7, 30 days after Ph TFBUT significantly decreased. By the 30 day after Ph the TFBUT was significantly increased in compare with 1 and 7 days after operation. TMH changes after Ph had multidirectional character and in general were not significant throughout the observation, with a tendency to increase on the 1 and 30 days after surgery and to decrease on the 7th day. IX dynamics in compare with a state before Ph was not significant in all control points with a tendency to its increase on the 1 and 7 days after operation and to decrease on the 30th day. In general, pharmacological support of Ph was assessed by all patients as comfortable, there was no intolerance. Conclusion: The cataract surgery pharmacological support in glaucoma patients (including 0.5 % levofloxacin, 0.09 % bromfenac and preservative free polyvinylpyrrolidone and polyvinyl alcohol fixed combination instillations) showed: high efficiency (in prevention of infectious and inflammatory complications); safety by influence on the ocular surface; comfort of use.

1. Berk T.A., Schlenker M.B., Campos-Moller X., Pereira A.M., Ahmed I.K. Visual and refractive outcomes in manual versus femtosecond laser-assisted cataract surgery: a single-centre retrospective cohort analysis of 1838 eyes. Ophthalmology. 2018;6. PII: S0161-6420(17)33311-0. DOI: 10.1016/j.ophtha.2018.01.028

2. Day A.C., Gore D.M., Bunce C., Evans J.R. Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery. Cochrane Database of Systematic Reviews. 2016; Issue 7. Art. No.: CD010735. DOI: 10.1002/14651858. CD010735.pub2

3. Craig J.P., Nelson J.D., Azar D.T., Belmonte C., Bron A.J., Chauhan S.K., de Paiva C.S., Gomes J.A.P., Hammit K.M., Jones L., Nichols J.J., Nichols J.S., Novak G.D., Stapleton F., Wilcox M.D.P., Wolffsohn J.S., Sullivan TFOS DEWS II Report Execu tive Summary. The Ocular Surface: 2017;XXX:1–11. DOI: 10.1016/j.jtos.2017.08.003

4. Сho Y.K., Kim M.S. Dry eye after cataract surgery and associated intraoperative risk factors. Korean J Ophthalmol. 2009;23(2):65–73. DOI: 10.3341/kjo.2009.23.2.65

5. Ram J., Gupta A., Brar G.S., Kaushik S., Gupta A. Outcomes of phacoemulsification in patients with dry eye. J Cataract Refract Surg. 2002;8(28):1386–1389. DOI: 10.1016/S0886-3350(02)01387-1

6. Yu Y., Hua H., Wu M., Yu Y., Yu W., Lai K., Yao K. Evaluation of dry eye after femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2015;41(12):2614–23. DOI: 10.1016/j.jcrs.2015.06.036

7. Бойко А.А., Дубинкина В.О., Еременко А.И., Куликова О.В., Янченко С.В. Профилактика комбинированного синдрома сухого глаза у пациентов старшей возрастной группы после катарактальной хирургии. Клиническая офтальмология. 2006;3:122–125. [Boyko A.A., Dubinkina V.O., Eremenko A.I., Kulikova O.V., Yanchenko S.V. Prevention of combined dry eye syndrome in patients of older age group after cataract surgery. Clinical ophthalmology = Klinicheskaya Oftalmolodiya. 2006:3;122–125 (In Russ.)]

8. Afsharkhamseh N., Movahedan A., Motahari H., Djalilian A.R. Cataract surgery in patients with ocular disease: an update in clinical diagnosis and treatment. Saudi Journal of Ophthalmology. 2014;28:164–167. DOI: 10/1016/j.sjopt.2014.06.013

9. Stapleton F., Optom M.C., Alves M., Bunya V.Y., Jalbert I., Lekhanont K., Malet F., Na Kyung-Sun, Schaumberg D., Ushino M., Vehof J., Viso E., Vitale S., Jones L., Optom F.C. TFOS DEWS II Epidemiology Report. The Ocular Surface. 2017;15:334– 365. DOI: 10.1016/j.jtos.2017.05.003

10. Baudouin C. Detrimental effect of preservatives in eye drops: implications for treatment of glaucoma. Acta Ophthalmol. 2008;86(7):716–26. DOI: 10.1111/j.17553768.2008.01250.x

11. Pisella P.J., Pouliquen P., Baudouin C. Prevalence of ocular symptoms and sings with preserved and preservative free glaucoma medication. Br J Ophthalmol. 2002;86:418–423.

12. Ramli N., Supramaniam G., Samsudin A., Juana A., Zahari M., Choo M.M. Ocular Disease in glaucoma: effect of polypharmacy and preservatives. Optom Vis Sci. 2015;92(9):e222–6. DOI: 10.1097/OPX.0000000000000542

13. Астахов С.Ю., Ткаченко Н.В. Первый опыт применения бета-блокаторов без консерванта. Офтальмологические ведомости. 2010;2(III):68–70. [Astakhov S.Yu., Tkachenko N.V. The first experience of using beta blockers without preservative. Ophthalmology journal = Oftal’mologicheskie vedomosti. 2010;2(III):68–70 (In Russ.)]

14. Янченко С.В., Еременко А.И. Особенности морфологического статуса конъюнктивы глазной поверхности у больных открытоугольной глауко мой, длительно получавших инстилляции бета-блокаторов с консервантом, в условиях вторичного синдрома «сухого глаза». Клиническая офтальмология. 2008;9(4):133–135. [Yanchenko S.V., Eremenko A.I. Peculiarities of the morphological status of the conjunctiva of the ocular surface in patients with open-angle glaucoma who received long-term instillations of beta blockers with a preservative under conditions of a secondary dry eye syndrome. Clinical ophthalmology = Klinicheskaya Oftalmolodiya. 2008;9(4):133–135 (In Russ.)]

15. Егоров Е.А., Алексеев В.Н., Астахов Ю.С., Бржеский В.В. Рациональная фармакотерапия в офтальмологии: М., 2011:1072. [Egorov E.A., Alekseev V.N., Astakhov Yu.S., Brzhesky V.V. Rational pharmacotherapy in ophthalmology. M., 2011:1072 (In Russ.)]

16. Kim S.Y., Lim J.A., Choi J.S., Choi E.C., Joo C.K. Comparison of antibiotic effect and corneal epithelial toxicity of levofloxacin and moxifloxacin in vitro. Cornea. 2007;26(6):720–5. DOI:10.1097/ICO.0b013e3180515251

17. Wolf E.J., Braunstein A., Shih C, Braunsein R.E. Incidence of visually significant pseudophakic macular edema after phacoemulsification in patient treated with nepafenac. J Cataract Refract Surg. 2007;33(9):1546–1549.

18. Cho H., Wolf K.J., Wolf E.J. Management of ocular inflammation and pain following cataract surgery: focus on bromfenac ophthalmic solution. Clinical Ophthalmology. 2009;3:199–210.

19. Miyanaga M., Miyai T., Nejima R., Maruyama Y., Miyata K., Kato S. Effect of bromfenac ophthalmic solution on ocular inflammation following cataract surgery. Acta Ophthalmologica. 2009;87:300–305. DOI: 10.1111/j.1755-3768.2008.014.33.x

20. Слонимский А.Ю., Слонимский Ю.Б., Обрубов А.С. Новый нестероидный противовоспалительный препарат при лечении различной офтальмопатологии. Офтальмология. 2016;1(13):33–37. [Slonimskij A.J., Slonimskij J.B., Obrubov A.S. New nonsteroidal anti-inflammatory drug in treatment of different ocular pathology. Ophthalmology = Oftalmologija. 2016;1(13):33–37 (In Russ.)]. DOI:10.18008/1816-5095-2016

21. Бржеский В.В., Егорова Г.Б., Егоров Е.А. Синдром «сухого глаза» и заболевания глазной поверхности. М.: ГЭОТАР-Медиа, 2016:448. [Brzhesky V.V., Egorova G.B., Egorov E.A. Dry eye and ocular surface diseases. GEOTAR-Media, 2016:448 (In Russ.)]

22. Аветисов С.Э., Егоров Е.А., Мошетова Л.К., Нероев В.В., Тахчиди Х.П. Офтальмология: нац. руководство. М.: ГЭОТАР-Медиа, 2014:736. [Avetisov S.E., Egorov E.A., Moshetova L.K., Neroev V.V., Tahchidi H.P. Ophthalmology: national guidelines. GEOTAR-Media, 2016:448 (In Russ.)]

23. Lumbroso B., Rispoli M. ОКТ сетчатки. Метод анализа и интерпретации. М.: Апрель, 2012:84. [Lumbroso B., Rispoli M. OCT of the retina. Method of analysis and interpretation. Aprel, 2012:84 (In Russ.)]

24. Bijesterveld O.P. Diagnostic tests in the sicca syndrome. Arch Ophthalmol. 1969;82:10–14.

25. Шипилов В.А., Янченко С.В., Сахнов С.Н., Малышев А.В., Эксузян З.А. Фиксатор устройства для получения фотоизображений «глазной поверхности». Современные проблемы науки и образования. 2013;6:689–690. URL: www. science-education.ru/113-11843 [Shipilov V.A., Yanchenko S.V., Sakhnov S.N., Malyshev A.V., Jeksuzjan Z.A. Latch device for obtaining photos of ocular surface. Modern problems of science and education = Sovremennie problemi nauki I obrazovaniya. 2013;6:689–690 (In Russ.)]