Cataract surgery and nonsteroidal antiinflammatory drugs.

Nonsteroidal antiinflammatory drugs (NSAIDs) have become an important adjunctive tool for surgeons performing routine and complicated cataract surgery. These medications have been found to reduce pain, prevent intraoperative miosis, modulate postoperative inflammation, and reduce the incidence of cystoid macular edema (CME). Whether used alone, synergistically with steroids, or for specific high-risk eyes prone to the development of CME, the effectiveness of these medications is compelling. This review describes the potential preoperative, intraoperative, and postoperative uses of NSAIDs, including the potency, indications and treatment paradigms and adverse effects and contraindications. A thorough understanding of these issues will help surgeons maximize the therapeutic benefits of these agents and improve surgical outcomes. FINANCIAL DISCLOSURE: Proprietary or commercial disclosures are listed after the references.

The role of latanoprost in an inflammatory bowel disease flare.

Ulcerative colitis and Crohn's disease (CD) are characterized by inflammation of the intestinal mucosa and symptoms of abdominal pain and diarrhea. Many studies have shown an association between elevated levels of prostaglandins and mucosal damage in inflammatory bowel disease. We report a 50-year-old woman with a history of CD and open-angle glaucoma. Her glaucoma was treated with latanoprost, a prostaglandin analog, which was associated with an exacerbation of her CD. On discontinuation of latanoprost, her CD symptoms disappeared completely. This case suggests that in a patient with CD, topical administration of latanoprost may result in sufficient systemic absorption and circulation to promote a relapse of CD. This finding has important implications, not only for patients with inflammatory bowel disease and glaucoma, but also for both ophthalmologists and gastroenterologists.

Tube fenestrations in Baerveldt Glaucoma Implant surgery: 1-year results compared with standard implant surgery.

PURPOSE: To evaluate the efficacy and safety of tube fenestrations in eyes undergoing polyglactin suture-ligated Baerveldt Glaucoma Implant surgery. PATIENTS AND METHODS: The authors performed a retrospective nonrandomized comparative interventional study of consecutive cases of 111 eyes of 111 patients with refractory glaucoma who received polyglactin (Vicryl) suture-ligated Baerveldt 350 implants as a single procedure. In 69 of these cases (group 1), fenestrations were placed anterior to the ligature using a suture needle. In 42 cases (group 2), no fenestrations were performed. Main outcome measures included intraocular pressure, visual acuity, and complications. RESULTS: Mean (+/- SD) preoperative intraocular pressure was 36.7 +/- 10.2 mm Hg in group 1 and 28.3 +/- 10.3 mm Hg in group 2 (P <0.001). Postoperative mean intraocular pressure was lower in group 1 than in group 2 at day 1 (20.2 +/- 12.8 vs. 29.3 +/- 1.9 mm Hg, P <0.001) and week 1 (18.3 +/- 10.4 vs. 23.7 +/- 8.6 mm Hg, P = 0.006), but was virtually identical at 1 year (12.7 +/- 4.9 vs. 12.6 +/- 4.4 mm Hg, P = 0.95). Number of glaucoma medications used by group 1 patients was significantly lower up to 3 months (P