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J.S. Hayes, R.N. Khurana, M.K. Dea; The Incidence Of Cystoid Macular Edema Diagnosed By Optical Coherence Tomography After Uncomplicated Cataract Surgery By Resident Surgeons . Invest. Ophthalmol. Vis. Sci. 2006;47(13):657.
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Studies have shown that roughly 11% of eyes have angiographic evidence of cystoid macular edema (CME) following uncomplicated extracapsular cataract extraction. Given longer operating times and increased manipulation of the iris and other anterior segment structures, this rate may be even higher when cataract extraction is performed by beginning surgeons. In this study we use a newer technology, optical coherence tomography, to find the rate of CME after uncomplicated phacoemulsification extracapsular cataract extraction performed by resident surgeons.
Using a Zeiss Stratus OCT Model 3000 radial line scans through the macula were produced to determine the central foveal thickness and the presence of macular edema and cysts. Macular thickness maps were obtained on consecutive eyes following uncomplicated cataract extraction by two surgeons (RNK, MKD). OCT’s were obtained after post–operative week 1, week 3, week 6 and every 3 weeks thereafter. Patients included in this study had follow–up for at least 4 weeks following surgery. 16 patients were identified that had uncomplicated surgeries, serial OCT’s and adequate length of follow–up. A chart review was performed noting history of diabetes mellitus, presence of clinically evident CME and final best corrected visual acuity.
One patient was excluded from the study because of the presence of a visually significant epiretinal membrane. Among the 15 patients included in the study 5 (33.3%) were found to have CME by OCT. CME was evident by dilated funduscopic examination in only 4 of these 5 patients. 10 (66.7%) patients in our study group had DM and 4 (40%) of these patients developed CME. The final best corrected visual acuity was 20/30 or better in 90% of patients with no CME but was 20/30 or better in only 40% of patients with CME. The thickest central foveal thickness (CFT) averaged 168 microns among patients without CME. The average thickest CFT was 269 among patients with CME. This is a statistically significant difference with p= 0.017.
In our study 1/3 of patients developed OCT evidence of CME. This may reflect a higher rate of CME among resident surgeons even in uncomplicated cases. Further studies with larger sample sizes and longer follow–up are necessary to confirm these findings. If confirmed, future recommendations may include more aggressive treatment with topical steroidal and nonsteroidal medications for these patients.
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