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Uveitis and cystoid macular oedema secondary to topical prostaglandin analogue use in ocular hypertension and open angle glaucoma
  1. Jason Hu1,
  2. James Thinh Vu1,
  3. Brian Hong1,
  4. Chloe Gottlieb1,2,3
  1. 1 University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
  2. 2 University of Ottawa Eye Institute, Ottawa, Ontario, Canada
  3. 3 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  1. Correspondence to Dr Chloe Gottlieb, University of Ottawa Eye Institute, TOH General Campus, CCW Box 307, Ottawa, ON K1H 8L6, Canada; cgottlieb{at}


Background Of the side effects of prostaglandin analogues (PGAs), uveitis and cystoid macular oedema (CME) have significant potential for vision loss based on postmarket reports. Caution has been advised due to concerns of macular oedema and uveitis. In this report, we researched and summarised the original data suggesting these effects and determined their incidence.

Methods Preferred Reporting Items for Systematic review and Meta-Analyses guidelines were followed. Studies evaluating topical PGAs in patients with ocular hypertension or open angle glaucoma were included. MEDLINE, PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, LILACS and were searched between 1946 and 2019. Experimental studies, animal studies and randomised studies with other intraocular pressure-lowering eye drops were excluded.

Results 214 studies (28 232 patients) met the inclusion criteria. Using prospective data, the incidence of uveitis and CME among PGA users were 62/28 232 (0.22%) and 25/28 232 (0.09%), respectively. A higher frequency of both uveitis and CME were found among latanoprost users compared with bimatoprost. There were 21 case studies reporting CME including 48 eyes in 43 patients. 47 of 48 eyes (97.9%) had previous incisional ocular surgery. 8 eyes were re-challenged, of which 7 (87.5%) recurred. 7 case studies reported uveitis in 15 eyes of 10 patients. 7 of 15 eyes (46.7%) were either pseudophakic or aphakic. 6 eyes were re-challenged, and all 6 (100%) recurred.

Conclusions Cases of uveitis or CME revealed a confounding effect of ocular surgery, aphakia or subluxed intraocular lens. PGAs may be used in non-surgical patients without concern of causing CME or uveitis. The incidences of PGA-associated CME and uveitis are rare with limited prospective studies on the cause-effect relationship.

  • glaucoma
  • macula
  • pharmacology
  • inflammation

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  • Correction notice This article has been corrected since it was published Online First. Minor formatting has been corrected.

  • Contributors Conception and design: CG. Data collection: Hu, Hong, Vu. Analysis and interpretation: Hu, Hong, Vu. Overall responsibility: Hu, Hong, Gottlieb, Vu.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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