Overview
Prostaglandin agonists remain a core component of glaucoma care, yet they can contribute to or exacerbate macular oedema, even in patients without prior macular disease. This short video presents two clear examples in which withdrawal of the prostaglandin and topical non-steroidal therapy resulted in resolution of oedema and recovery of visual acuity. The aim is to reinforce careful review of macular status when prescribing or continuing prostaglandins, particularly in complex or inflammatory cases. The reminders here are practical, common, and clinically relevant.
Video on YouTube
Prostaglandin agonists can occasionally cause or worsen macular oedema, even in patients without prior macular pathology, find out more in the video, or read on below.
🔞 This video is age-restricted. Please watch it on YouTube.
Key points
- Prostaglandin agonists can cause macular oedema in susceptible patients.
- Assess for macular changes when visual acuity declines after initiating prostaglandins.
- Withdrawal of the prostaglandin can lead to resolution of oedema.
- Topical non-steroidal treatment may support recovery of the macula.
- Remain cautious when balancing IOP control and macular status in complex glaucoma.
Transcript
Prostaglandin Agonists and Macular Oedema
In this video I highlight a non-surgical glaucoma problem that we are all generally aware of, yet I am increasingly seeing in practice. Prostaglandin agonists revolutionised glaucoma management in the late 1990s, and we are aware that they can occasionally cause macular oedema in patients such as aphakes. However, it still surprises me how often I am referred patients with chronic, intractable macular oedema who are about to have a steroid implant, such as Ozurdex or Iluvien, and the surgeon is concerned that the pressure will become difficult to control — yet the patient is still on Lumigan or Xalatan.
It is obviously very difficult to differentiate the relative contribution of the drug and the disease to the macular oedema in eyes such as uveitics. In this video I am going to show two much less complex cases, simply to highlight the potential for prostaglandin agonists to cause macular oedema. I hope you find this useful.
Read more
This video illustrates the potential of prostaglandin agonists to cause or exacerbate macular oedema, even in patients without prior macular pathology. Withdrawal of the prostaglandin and treatment with topical non-steroidals can result in resolution and improvement of visual acuity. Clinicians should maintain a high index of suspicion when managing glaucoma in patients with concurrent or unexplained macular oedema.
Case 1: Macular Oedema After Starting Prostaglandin Agonist
This macular OCT is from an 85-year-old patient on no glaucoma medication in February 2021. [01:40]
This is the same macula nine months later, and five months after starting latanoprost for intraocular pressure elevation. [01:53]
One month after latanoprost withdrawal and topical non-steroidal treatment, the macula is almost back to normal. [02:05]
Case 2: Reversible Visual Acuity Reduction with Macular Oedema
Here is a second patient, an 80-year-old with a visual acuity of 6/6 and a pressure of 25 mmHg before starting latanoprost.
Six months later, the visual acuity has reduced to 6/12 best-corrected, and this is the macular OCT. [02:30]
Two months later, on Acular and Cosopt, after latanoprost withdrawal, the visual acuity is 6/6 again and the macula is normal. [02:40]
Key Reminder
These cases remind us that we must be cautious with prostaglandin usage in patients who have macular oedema. They can cause macular oedema in patients who have had no previous macular problems.
For outcome benchmarking, see the International Glaucoma Surgery Registry.
