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Tanuj Banker, James M Osher, Kristen Midgley, Michael Lai; Internal limiting membrane peeling’s influence on rates of cystoid macular edema following cataract surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):295.
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To analyze the outcomes and complications following cataract extraction (CE) in eyes which had previously undergone small gauge (23/25g) pars plana vitrectomy (PPV) with epiretinal membrane (ERM) peeling. Risk factors potentially associated with increased rates of cystoid macular edema (CME) were also identified.
A consecutive interventional case series from 2010 to 2012 (n=81) by one group of retinal surgeons who performed PPV with ERM peeling using small gauge instrumentation in phakic eyes. Exclusion criteria included pre-existing macular disease, postoperative retinal detachment, previous PPV, documented follow-up of less than three months, combined MP/CE/PCIOL, and eyes that remained phakic during the postoperative period. Postoperative CME was confirmed with Spectral Domain Optical Coherence Tomography (SD-OCT) and fluorescein angiography (FA). Primary outcome measure was the rate of CME after CE. Secondary outcome measures included visual acuity (VA) assessment.
Eighty-one eyes with a mean age of 65.16 +/- 11.7 years were followed for a mean time of 579 days. The mean preoperative VA was 20/70 (logMAR 0.52), improving to 20/50 (logMAR 0.44) post-MP prior to CE. (p < 0.05). The mean VA prior to CE/PCIOL placement was 20/200 (logMAR 1.0), improving to 20/50 (logMAR 0.37) post-operatively (p < 0.01). Post CE/PCIOL placement, 22.2% of eyes (n=18) had CME with a mean central macular thickness (CMT) of 426.23 microm ± 79.5 vs. 335.04 microm ± 68.7 for eyes without CME (p<.01). 61.7% (n=50) of MP procedures included intraoperative ILM peeling. Eyes with ILM peeling had a CMT of 356.31 microm ± 91.32 vs. 362.94 microm ± 95.85 for eyes without ILM peeling (p>.81).
MP with PPV is an effective treatment for visually significant ERM and results in improved visual acuity. CME develops frequently after CE/PCIOL in eyes that have undergone previous MP. Peeling the ILM does not appear to alter the risk of CME. SD-OCT is an effective tool in monitoring postoperative CME. Eyes undergoing CE/PCIOL placement after MP require careful monitoring with OCT to evaluate for postoperative CME.
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