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S. J. Kim, D. F. Martin, G. Hubbard, III, S. K. Srivastava, J. Yan, C. S. Bergstrom, T. M. Aaberg, Sr.; Incidence of Post-Vitrectomy Macular Edema Using Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6050.
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To evaluate the incidence, effect on visual recovery, and predisposing risk factors of post-vitrectomy macular edema (ME).
A consecutive cohort of 109 eyes of 109 patients undergoing non-emergent vitrectomy surgery were prospectively evaluated for postoperative day 1 inflammation, 1-month retinal thickness using optical coherence tomography, and preoperative and 1-month postoperative best-corrected visual acuity (BCVA). ME was defined as central subfield thickness greater than or equal to 272 µm. Main outcome measures were retinal thickness, inflammation, and BCVA.
Incidence of ME on optical coherence tomography was 47% overall (95% confidence interval (CI) 37% to 56%), but varied significantly by preoperative diagnosis. Mean 1 month visual acuity improved 3.3 lines (0.33 logmar units) to 20/80+1 (0.58 ± 0.46 logmar units) from 20/150-2 (0.91 ± 0.63 logmar units) preoperatively (P < 0.001). Mean 1 month center point thickness (CPT), central subfield (CSF), and total macular volume were 265 ± 107 µm, 288 ± 94 µm, and 7.8 ± 1.2 mm3 respectively. Severity of postoperative inflammation predicted retinal thickness at 1 month (P < 0.05). Intraoperative epinephrine use was associated with increased postoperative inflammation (P = 0.02). Eyes with greater reduction in CSF (or CPT) from baseline experienced more rapid visual recovery (r = -0.36 [95% CI: -0.61 to -0.06], P = 0.02).
Post-vitrectomy ME is common and delays visual recovery. Degree of postoperative inflammation is an important risk factor for ME and in this series, was increased in the setting of intraocular epinephrine. Efforts to reduce or prevent inflammation after vitrectomy should be beneficial and therefore encouraged.
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