Colin J Chu1, Robert L Johnston2, Charlotte Buscombe3, Ahmed B Sallam4, Queresh Mohamed3, Yit C Yang5. 1. School of Clinical Sciences, University of Bristol and Bristol Eye Hospital, Bristol, United Kingdom. 2. Gloucestershire Eye Unit, Cheltenham General Hospital, Sandford Road, Cheltenham, United Kingdom. Electronic address: Rob.Johnston@glos.nhs.uk. 3. Gloucestershire Eye Unit, Cheltenham General Hospital, Sandford Road, Cheltenham, United Kingdom. 4. Gloucestershire Eye Unit, Cheltenham General Hospital, Sandford Road, Cheltenham, United Kingdom; Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 5. Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, New Cross, Wolverhampton, United Kingdom; Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom.
Abstract
PURPOSE: To define the incidence of pseudophakic macular edema (PME) after cataract surgery and to identify contributory risk factors. DESIGN: Retrospective database study of electronic medical records (EMRs). PARTICIPANTS: A total of 81984 eyes undergoing cataract surgery between December 2010 and December 2014 from 8 independent United Kingdom clinical sites. METHODS: Structured clinical data mandated by the EMR were anonymized and extracted for each eye undergoing cataract surgery including: perioperative visual acuity, copathologic features, simultaneous surgical procedures, and the presence or absence of a specified list of intraoperative complications. Diabetic status with matched Early Treatment Diabetic Retinopathy Study (ETDRS) grading also was mandated by the EMR. Eyes receiving prophylactic nonsteroidal anti-inflammatory drugs were excluded. MAIN OUTCOME MEASURE: Diagnosis of cystoid macular edema or new-onset macular edema in patients with diabetes, recorded by a healthcare professional within 90 days of surgery. RESULTS: Baseline incidence of PME in eyes without operative complications, diabetes, or risk factors was 1.17%. Eyes in which PME developed were more likely to be male, older, and to demonstrate risk factors. The relative risk (RR) was increased in eyes with capsule rupture with or without vitreous loss (RR, 2.61; 95% confidence interval [CI], 1.57-4.34), a previous diagnosis of epiretinal membrane (RR, 5.60; 95% CI, 3.45-9.07), uveitis (RR, 2.88; 95% CI, 1.50-5.51), retinal vein occlusion (RR, 4.47; 95% CI, 2.56-5.92), or retinal detachment repair (RR, 3.93; 95% CI, 2.60-5.92). High myopia, age-related macular degeneration, or prostaglandin analog use were not shown to increase risk. Eyes with PME on average had poorer postoperative visual acuity, which persisted to the latest time point assessed, up to 24 weeks. Eyes from patients with diabetes, even in the absence of retinopathy, had an increased RR (RR, 1.80; 95% CI, 1.36-2.36) of new macular edema after surgery. The risk was higher in the presence of any diabetic retinopathy (DR; RR, 6.23; 95% CI, 5.12-7.58) and rose proportionately with increasing severity of DR. CONCLUSIONS: Pseudophakic macular edema occurs commonly after phacoemulsification cataract surgery, even in the absence of complications and risk factors. This large retrospective study using structured EMR data quantified the RRs of PME and the risk with increasing ETDRS severity of DR. It highlights the need for prophylactic therapy, especially in those groups of eyes with the highest RRs.
PURPOSE: To define the incidence of pseudophakic macular edema (PME) after cataract surgery and to identify contributory risk factors. DESIGN: Retrospective database study of electronic medical records (EMRs). PARTICIPANTS: A total of 81984 eyes undergoing cataract surgery between December 2010 and December 2014 from 8 independent United Kingdom clinical sites. METHODS: Structured clinical data mandated by the EMR were anonymized and extracted for each eye undergoing cataract surgery including: perioperative visual acuity, copathologic features, simultaneous surgical procedures, and the presence or absence of a specified list of intraoperative complications. Diabetic status with matched Early Treatment Diabetic Retinopathy Study (ETDRS) grading also was mandated by the EMR. Eyes receiving prophylactic nonsteroidal anti-inflammatory drugs were excluded. MAIN OUTCOME MEASURE: Diagnosis of cystoid macular edema or new-onset macular edema in patients with diabetes, recorded by a healthcare professional within 90 days of surgery. RESULTS: Baseline incidence of PME in eyes without operative complications, diabetes, or risk factors was 1.17%. Eyes in which PME developed were more likely to be male, older, and to demonstrate risk factors. The relative risk (RR) was increased in eyes with capsule rupture with or without vitreous loss (RR, 2.61; 95% confidence interval [CI], 1.57-4.34), a previous diagnosis of epiretinal membrane (RR, 5.60; 95% CI, 3.45-9.07), uveitis (RR, 2.88; 95% CI, 1.50-5.51), retinal vein occlusion (RR, 4.47; 95% CI, 2.56-5.92), or retinal detachment repair (RR, 3.93; 95% CI, 2.60-5.92). High myopia, age-related macular degeneration, or prostaglandin analog use were not shown to increase risk. Eyes with PME on average had poorer postoperative visual acuity, which persisted to the latest time point assessed, up to 24 weeks. Eyes from patients with diabetes, even in the absence of retinopathy, had an increased RR (RR, 1.80; 95% CI, 1.36-2.36) of new macular edema after surgery. The risk was higher in the presence of any diabetic retinopathy (DR; RR, 6.23; 95% CI, 5.12-7.58) and rose proportionately with increasing severity of DR. CONCLUSIONS:Pseudophakic macular edema occurs commonly after phacoemulsification cataract surgery, even in the absence of complications and risk factors. This large retrospective study using structured EMR data quantified the RRs of PME and the risk with increasing ETDRS severity of DR. It highlights the need for prophylactic therapy, especially in those groups of eyes with the highest RRs.
Authors: Eduard Pedemonte-Sarrias; Toni Salvador Playà; Irene Sassot Cladera; Oscar Gris; Joan Ribas Martínez; José García-Arumí; Núria Giménez Journal: Int J Ophthalmol Date: 2017-07-18 Impact factor: 1.779
Authors: Joshua S Hardin; Donald W Gauldin; Mohamed K Soliman; Colin J Chu; Yit C Yang; Ahmed B Sallam Journal: JAMA Ophthalmol Date: 2018-02-01 Impact factor: 7.389
Authors: Friederike Schaub; Werner Adler; Philip Enders; Meike C Koenig; Konrad R Koch; Claus Cursiefen; Bernd Kirchhof; Ludwig M Heindl Journal: Graefes Arch Clin Exp Ophthalmol Date: 2018-03-21 Impact factor: 3.117
Authors: John C Buchan; Winfried Amoaku; Beth Barnes; Andy Cassels-Brown; Bernard Y Chang; Jane Harcourt; Darren Shickle; Anne Fiona Spencer; Stephen A Vernon; Carrie MacEwen Journal: Eye (Lond) Date: 2018-02-09 Impact factor: 3.775
Authors: Grigorios Triantafyllidis; Mircea Filip; Raluca Moisescu; Andrei Filip; Carmen Dragne; Miruna Nicolae Journal: Rom J Ophthalmol Date: 2016 Jul-Sep