Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Irvine S (1953) A newly defined vitreous syndrome following cataract surgery. Am J Ophthalmol 36:599–619

    Article  CAS  PubMed  Google Scholar 

  2. Gass JDM, Norton EWD (1966) Fluorescein studies of patients with macular edema and papilloedema following cataract extraction. Trans Am Ophthalmol Soc 64:232–249

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Yonekawa Y, Kim I (2012) Pseudophakic cystoid macular edema. Curr Opin Ophthalmol 23:26–32

    Article  PubMed  Google Scholar 

  4. Miyake K, Ibaraki N, Goto Y, Oogiya S, Ishigaki J, Ota I et al (2003) ESCRS Binkhorst lecture 2002. J Cataract Refract Surg 29:1800–1810

    Article  PubMed  Google Scholar 

  5. Freeman P, Kahook M (2009) Preservatives in topical ophthalmic medications: historical and clinical perspectives. Expert Rev Ophthalmol 4:59–64

    Article  Google Scholar 

  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 32:3–8

    Article  CAS  PubMed  Google Scholar 

  7. Grant W (1974) Toxicology of the eye. Thomas, Springfield

    Google Scholar 

  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 82:39–42

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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 20:85–94

    Article  Google Scholar 

  10. Hee MR, Puliafito CA, Wong C et al (1995) Quantitative assessment of macular edema with optical coherence tomography. Arch Ophthalmol 113:1019–1029

    Article  CAS  PubMed  Google Scholar 

  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 29:1511–1516

    CAS  PubMed  Google Scholar 

  12. Flach AJ (1998) The incidence, pathogenesis and treatment of cystoid macular edema following cataract surgery. Trans Am Ophthalmol Soc 96:557–634

    CAS  PubMed  PubMed Central  Google Scholar 

  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 978-953-51-0975-4

  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):1765–1771

    Article  Google Scholar 

  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 2013:376013

    PubMed  PubMed Central  Google Scholar 

  16. Akcay BI, Bozkurt TK, Guney E et al (2012) Quantitative analysis of macular thickness following uneventful and complicated cataract surgery. Clin Ophthalmol 6:1507–1511

    Article  PubMed  PubMed Central  Google Scholar 

  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 32:241–247

    Article  PubMed  Google Scholar 

  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 34:1036–1041

    Article  PubMed  Google Scholar 

  19. Sourdille P, Santiago P (1999) Optical coherence tomography of macular thickness after cataract surgery. J Cataract Refract Surg 25:256–261

    Article  CAS  PubMed  Google Scholar 

  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 53:246

    Article  Google Scholar 

  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 4:33–39

    Article  Google Scholar 

  22. Moreira Neto C, Moreira Júnior C, Moreira A (2015) Optical coherence tomography in patients undergoing cataract surgery. Arq Bras Oftalmol 78:241–245

    Article  PubMed  Google Scholar 

  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 94:189–194

    Article  CAS  Google Scholar 

  24. Arora S (2012) OCT provides insights into retinal changes after uneventful cataract surgery. Ocul Surg News. Retrieved from https://www.healio.com/ophthalmology/retina-vitreous/news/print/ocular-surgery-news-europe-edition/%7B57b2f345-acb4-4f48-88bb-18f613f3f0dd%7D/oct-provides-insights-into-retinal-changes-after-uneventful-cataract-surgery

  25. Puliafito CA, Hee MR, Lin CP et al (1995) Imaging of macular diseases with optical coherence tomography. Ophthalmology 102:217–229

    Article  CAS  PubMed  Google Scholar 

  26. Stein DM, Ishikawa H, Hariprasad R et al (2006) A new quality assessment parameter for optical coherence tomography. Br J Ophthalmol 90:186–190

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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 26:57–77

    Article  PubMed  Google Scholar 

  28. Hee MR, Puliafito CA, Duker JS et al (1998) Topography of diabetic macular edema with optical coherence tomography. Ophthalmology 105:360–370

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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 119:387

    Article  CAS  PubMed  Google Scholar 

  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 30:413–418

    Article  CAS  PubMed  Google Scholar 

  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 6:1110

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, New Delhi, 110029, India

    Harinder Singh Sethi, Sugourab Das, Mayuresh P. Naik & Rajshekhar Vemparala

Authors
  1. Harinder Singh Sethi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sugourab Das
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mayuresh P. Naik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rajshekhar Vemparala
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mayuresh P. Naik.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sethi, H.S., Das, S., Naik, M.P. et al. BKC and CME: Is benzalkonium chloride hindering our efforts to achieve the desired postoperative visual acuity?. Int Ophthalmol 39, 2129–2136 (2019). https://doi.org/10.1007/s10792-018-1051-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-018-1051-7

Keywords

Search

Navigation