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International Ophthalmology

, Volume 39, Issue 9, pp 2129–2136 | Cite as

BKC and CME: Is benzalkonium chloride hindering our efforts to achieve the desired postoperative visual acuity?

  • Harinder Singh Sethi
  • Sugourab Das
  • Mayuresh P. NaikEmail author
  • Rajshekhar Vemparala
Original Paper
  • 41 Downloads

Abstract

Purpose

To evaluate and compare the change in postoperative central macular thickness in patients receiving benzalkonium chloride (BKC)-preserved and BKC-free medications after uneventful phacoemulsification.

Setting

V.M.M.C & Safdarjung Hospital, New Delhi (a tertiary health care hospital).

Study design

Prospective randomized comparative observational study.

Materials and methods

Once patients were selected, the baseline standard ophthalmic examination was done. Sample size: 140 eyes were enrolled and randomly divided into two groups. (a) Group I: receive BKC-preserved topical medications and (b) Group II: receive BKC-free topical medications of same constituents postoperatively. Group I patients received topical BKC-preserved moxifloxacin 0.5% + dexamethasone 0.1% eye drops six times a day, timolol maleate 0.5% twice daily, tropicamide 0.8% + phenylephrine 5% once a day for 6 weeks, and Group II received same BKC-free topical eye drops for 6 weeks. Postoperatively, the patients were reviewed at day 1, week 1, week 6 for same parameters.

Statistics

Quantitative variables: paired and unpaired t test. p value < 0.05 was considered statistically significant.

Results

The mean CMT in μm at 1 week in Group I was 269.39 ± 14.56 and in Group II was 270.04 ± 6.56. The mean CMT in µm at 6 weeks in Group I was 270.39 ± 17.18 and in Group II was 270.90 ± 7.00.

Conclusion

Neither do BKC-preserved topical medications have any independent role in increasing the central macular thickness after uneventful surgery nor do they have any role in causing pseudophakic CME.

Keywords

BKC CME Phacoemulsification 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Irvine S (1953) A newly defined vitreous syndrome following cataract surgery. Am J Ophthalmol 36:599–619CrossRefGoogle Scholar
  2. 2.
    Gass JDM, Norton EWD (1966) Fluorescein studies of patients with macular edema and papilloedema following cataract extraction. Trans Am Ophthalmol Soc 64:232–249Google Scholar
  3. 3.
    Yonekawa Y, Kim I (2012) Pseudophakic cystoid macular edema. Curr Opin Ophthalmol 23:26–32CrossRefGoogle Scholar
  4. 4.
    Miyake K, Ibaraki N, Goto Y, Oogiya S, Ishigaki J, Ota I et al (2003) ESCRS Binkhorst lecture 2002. J Cataract Refract Surg 29:1800–1810CrossRefGoogle Scholar
  5. 5.
    Freeman P, Kahook M (2009) Preservatives in topical ophthalmic medications: historical and clinical perspectives. Expert Rev Ophthalmol 4:59–64CrossRefGoogle Scholar
  6. 6.
    Pisella P, Fillacier K, Elena P, Debbasch C, Baudouin C (2000) Comparison of the effects of preserved and unpreserved formulations of timolol on the ocular surface of albino rabbits. Ophthalmic Res 32:3–8CrossRefGoogle Scholar
  7. 7.
    Grant W (1974) Toxicology of the eye. Thomas, SpringfieldGoogle Scholar
  8. 8.
    Baudouin C, de Lunardo C (1998) Short term comparative study of topical 2% carteolol with and without benzalkonium chloride in healthy volunteers. Br J Ophthalmol 82:39–42CrossRefGoogle Scholar
  9. 9.
    De Saint Jean M, Debbasch C, Brignole F, Rat P, Warnet J, Baudouin C (2000) Toxicity of preserved and unpreserved antiglaucoma topical drugs in an in vitro model of conjunctival cells. Curr Eye Res 20:85–94CrossRefGoogle Scholar
  10. 10.
    Hee MR, Puliafito CA, Wong C et al (1995) Quantitative assessment of macular edema with optical coherence tomography. Arch Ophthalmol 113:1019–1029CrossRefGoogle Scholar
  11. 11.
    Hudes GR, Li WY, Rockey JH, White P (1988) Prostacyclin is the major prostaglandin synthesized by bovine retinal capillary pericytes in culture. Invest Ophthalmol Vis Sci 29:1511–1516Google Scholar
  12. 12.
    Flach AJ (1998) The incidence, pathogenesis and treatment of cystoid macular edema following cataract surgery. Trans Am Ophthalmol Soc 96:557–634Google Scholar
  13. 13.
    Tsilimbaris MK, Tsika C, Diakonis V, Karavitaki A, Pallikaris I (2013) Macular edema and cataract surgery, in cataract surgery. In: Zaid F (ed) Cataract surgery. InTech. ISBN 978-953-51-0975-4Google Scholar
  14. 14.
    Von Jagow B, Ohrloff C, Kohnen T (2007) Macular thickness after uneventful cataract surgery determined by optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 245(12):1765–1771CrossRefGoogle Scholar
  15. 15.
    Sahin M, Cingu AK, Gozum N (2013) Evaluation of cystoid macular edema using optical coherence tomography and fundus autofluorescence after uncomplicated phacoemulsification surgery. J Ophthalmol 2013:376013Google Scholar
  16. 16.
    Akcay BI, Bozkurt TK, Guney E et al (2012) Quantitative analysis of macular thickness following uneventful and complicated cataract surgery. Clin Ophthalmol 6:1507–1511CrossRefGoogle Scholar
  17. 17.
    Perente I, Utine CA, Ozturker C et al (2007) Evaluation of macular changes after uncomplicated phacoemulsifivcation surgery by optical coherence tomography. Curr Eye Res 32:241–247CrossRefGoogle Scholar
  18. 18.
    Cagini C, Fiore T, Iaccheri B, Piccinelli F, Ricci M, Fruttini D (2009) Macular thickness measured by optical coherence tomography in a healthy population before and after uncomplicated cataract phacoemulsification surgery. Curr Eye Res 34:1036–1041CrossRefGoogle Scholar
  19. 19.
    Sourdille P, Santiago P (1999) Optical coherence tomography of macular thickness after cataract surgery. J Cataract Refract Surg 25:256–261CrossRefGoogle Scholar
  20. 20.
    Yoo J, Kim S, Lee S, Lee S (2012) Changes in macular thickness after cataract surgery according to optical coherence tomography. J Korean Ophthalmol Soc 53:246CrossRefGoogle Scholar
  21. 21.
    Wang K, Cheng C (2014) Central retinal thickness changes and visual outcomes following uncomplicated small-incision phacoemulsification cataract surgery in diabetic without retinopathy patients and nondiabetic patients. Taiwan J Ophthalmol 4:33–39CrossRefGoogle Scholar
  22. 22.
    Moreira Neto C, Moreira Júnior C, Moreira A (2015) Optical coherence tomography in patients undergoing cataract surgery. Arq Bras Oftalmol 78:241–245CrossRefGoogle Scholar
  23. 23.
    Hwang H, Ahn Y, Lee H, Kim M, Kim E (2015) Comparison of macular thickness and inflammatory cytokine levels after microincision versus small incision coaxial cataract surgery. Acta Ophthalmol 94:189–194CrossRefGoogle Scholar
  24. 24.
  25. 25.
    Puliafito CA, Hee MR, Lin CP et al (1995) Imaging of macular diseases with optical coherence tomography. Ophthalmology 102:217–229CrossRefGoogle Scholar
  26. 26.
    Stein DM, Ishikawa H, Hariprasad R et al (2006) A new quality assessment parameter for optical coherence tomography. Br J Ophthalmol 90:186–190CrossRefGoogle Scholar
  27. 27.
    Van Velthoven ME, Faber DJ, Verbraak FD et al (2007) Recent developments in optical coherence tomography for imaging the retina. Prog Retin Eye Res 26:57–77CrossRefGoogle Scholar
  28. 28.
    Hee MR, Puliafito CA, Duker JS et al (1998) Topography of diabetic macular edema with optical coherence tomography. Ophthalmology 105:360–370CrossRefGoogle Scholar
  29. 29.
    Miyake K (2001) Enhanced disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema by topical timolol and its preservative in early postoperative pseudophakia. Arch Ophthalmol 119:387CrossRefGoogle Scholar
  30. 30.
    Abe R, Zacchia R, Santana P, Costa V (2014) Effects of benzalkonium chloride on the blood-aqueous and blood-retinal barriers of pseudophakic eyes. J Ocul Pharmacol Ther 30:413–418CrossRefGoogle Scholar
  31. 31.
    Chhabra H, Gupta A, Singh G (2017) A comparative study of benzalkonium chloride-free latanoprost versus benzalkonium chloride-preserved latanoprost on ocular surface health in patients of primary open angle glaucoma. Int J Basic Clin Pharmacol 6:1110CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Harinder Singh Sethi
    • 1
  • Sugourab Das
    • 1
  • Mayuresh P. Naik
    • 1
    Email author
  • Rajshekhar Vemparala
    • 1
  1. 1.Department of OphthalmologyV.M.M.C & Safdarjung HospitalNew DelhiIndia

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