Prostaglandin EP2 Receptor and Cystoid Macular Edema in Phakic Posttrabeculectomy Eyes

Omidenepag isopropyl (OMDI), a prostaglandin EP2 receptor agonist, effectively reduces intraocular pressure but has a known risk of cystoid macular edema (CME), particularly in pseudophakic and aphakic eyes. Its safety profile in patients with phakic eyes, especially those with prior glaucoma surgery, warrants clarification.

To provide clinical characteristics and disease course of CME associated with OMDI use in patients with phakic eyes.

This is a retrospective medical record review of patients at a tertiary medical center seen between March 1, 2023, and March 31, 2024. The study included patients who were treated with OMDI following the introduction of OMDI eye drops at the institution. Data were analyzed on December 6, 2024.

Topical OMDI ophthalmic solution, 0.002%, administered once daily.

Medical records were assessed on December 6, 2024, to characterize clinical findings before and after onset of OMDI-related CME, including ophthalmic examinations, optical coherence tomography (OCT) imaging findings, and treatment strategies, as well as time to anatomic recovery and visual acuity outcomes.

A total of 836 patients with phakic eyes were treated with OMDI, of whom 86 had a history of trabeculectomy. CME developed in 8 eyes from 6 patients with prior trabeculectomy (age range, 41-61 years; median, 52.5 years), all occurring between 6 and 11 months after treatment initiation. During the study, the follow-up period after OMDI initiation was less than 6 months in 366 patients, 6 to less than 12 months in 419 cases, and 12 months or more in 51 patients. Baseline visual acuities with correction (range, 6/6 [20/20] to counting fingers), measured with the tumbling E chart, declined by 0 to 3 lines following CME onset. Three eyes received topical nonsteroidal anti-inflammatory drug treatment, 2 eyes required systemic corticosteroids, and 3 eyes recovered by discontinuing OMDI alone without additional therapy. Visual acuities, after CME resolved, ranged from 6/6 (20/20) to counting fingers at 28 to 91 days after discontinuing OMDI. Among the CME cases, postresolution follow-up ranged from 5.5 to 12 months, with no recurrence observed during this period.

Cystoid macular edema can develop after initiating OMDI in patients with phakic eyes with a history of trabeculectomy prior to initiating OMDI. Further studies would be needed to understand the magnitude of this association and risk factors for this finding.