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The effect of indomethacin pretreatment before neodymium-YAG laser anterior capsulotomy on intraocular pressure of rabbits



The effect of indomethacin pretreatment before neodymium-YAG laser anterior capsulotomy on intraocular pressure of rabbits



Journal of Catholic Medical College 45(4): 1365-1374



The most frequent complication after Nd:YAG laser anterior capsulotomy in cataract is the elevation of intraocular pressure. Usually the increase of intraocular pressure is transient, but it could do permanent damage to optic nerve in advanced glaucoma. The purpose of this study is to evaluate the change of intraocular pressure following Nd:YAG laser anterior capsulotomy and the effect of indomethacin which has antiinflammatory and potent prostaglandin inhibitory effect. The experiment composed of 70 rabbit eyes divided into two groups of topical indomethacin pretreatment and non-treatment. Intraocular pressure, prostaglandin E-2 and thromboxane B-2 concentration in anterior chamber aqueous humor were measured for 24 hours after laser application. In addition, morphological change of trabecular meshwork was observed on the scanning electron microscope. The results were as follows: The intraocular pressure increased markedly and was maximum at 2 hours with 25.9 +- 5.7 mm Hg. And then decreased gradually during the subsequent experimental period, and it returned to normal level at 24 hours after laser application in the indomethacin non-treatment group. In the indomethacin pretreatment group, intraocular pressure, however, increased slightly and was maximum at 2 hours with 12.1 +- 2.0 mm Hg and returned to normal level at 12 hours. The change of intraocular pressure showed significant difference in two groups at 1 hour, 2 hours, 4 hours and 12 hours (P lt 0.01). The concentrations of prostaglandin E-2 and thromboxane B-2 in the indomethacin non-treatment group were substantially higher than those in the indomethacin pretreatment group at 1 hour, 2 hours, 4 hours and 12 hours after laser application (P lt 0.01). And the maximum concentrations were 3830 +- 148 and 7670 +- 511 pg/ ml at 2 hours respectively in the indomethacin non-treatment group. These concentrations increased by more than 70 and 30 fold after laser application respectively. Morphological change of endothelium of corneoscleral trabecular meshwork at 1 hour and 2 hours after laser application in both groups showed on the scanning electron microscopy. Even at 4 and 12 hours after laser application, inflammatory reaction was observed in indomethacin non-treatment group, which returned to normal in appearance at 24 hours following laser application. These results support that causes of elevated intraocular pressure are increased concentrations of prostaglandin E-2 and thromboxane B-2 in anterior chamber aqueous humor and inflammation of trabecular meshwork, and indomethacin pretreatment for Nd:YAG laser anterior capsulotomy is necessary to suppress the elevation of intraocular pressure.

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