Selective serotonin reuptake inhibitors may lead to improved cataract surgery outcomes in patients with amblyopia
Authors Xin KZ, Prescott CR
Received 27 April 2019
Accepted for publication 2 July 2019
Published 9 August 2019 Volume 2019:13 Pages 1517—1522
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Melinda Thomas
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Kevin Z Xin, Christina R Prescott
Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
Purpose: To evaluate the effects of selective serotonin reuptake inhibitor (SSRI)/serotonin norepinephrine reuptake inhibitor (SNRI) medications in combination with cataract surgery in treating amblyopia in adult patients.
Patients and methods: A retrospective chart review study was conducted on patients who had undergone cataract surgery at the Johns Hopkins Hospital Wilmer Eye Institute. Six inclusion criteria were used to assess patient eligibility: 1) >18 years of age, 2) diagnosis of amblyopia, 3) diagnosis of cataract and treatment with surgery, 4) electronic medical record contains pre-surgery and post-surgery visual acuity (VA) measurements, 5) electronic medical record contains information on whether the patient was ever prescribed a SSRI/SNRI and the treatment duration, and 6) interocular VA difference of two lines or more on Snellen chart prior to cataract surgery. From each record, preoperative VA, postoperative VA, date of surgery, date at which postoperative VA was measured, and age at surgery were collected.
Results: A total of 237 patients were included, with 38 of them being on SSRI/SNRI. The mean improvement in VA after surgery was not significantly greater in patients on SSRI/SNRI (SSRI/SNRI: −0.276 logMAR, control: −0.192 logMAR, p=0.15). Multivariable regression was subsequently performed and while holding all other variables constant, demonstrated a statistically significant improvement in VA in patients on SSRI/SNRI (95% CI: −0.194, −0.0116, p=0.03). The regression analysis further demonstrated that advanced age has an adverse effect on the change in post-op VA (CI: 3.34×10−3 logMAR, 9.77×10−3 logMAR, p<0.005). Worse baseline VA is associated with a greater improvement in post-op VA (95% CI: −0.659 logMAR, −0.463 logMAR, p<0.005) but adverse effect on the absolute post-op VA (95% CI: 0.341 logMAR, 0.544 logMAR, p<0.005).
Conclusion: This study suggests that patients with amblyopia undergoing cataract surgery may potentially have a greater visual improvement when treated with SSRI/SNRIs.
Keywords: amblyopia, cataract surgery, selective serotonin reuptake inhibitor (SSRI)/selective norepinephrine reuptake inhibitor, visual plasticity, dopamine
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