Macular Edema After Uneventful Phacoemulsification Detected By Ocular Coherence Tomography (OCT)

Abstract

Purpose: : To evaluate the incidence of clinical and subclinical macular edema using OCT in patients submitted to phacoemulsification cataract extraction.

Methods: : Non-randomized, prospective analysis of 78 eyes undergoing phacoemulsification. We defined ME as the presence of any amount of intraretinal fluid in the macula or central macular thickness (CMT) equal or greater than 250 microns in OCT. We considered subclinical edema in patients with best corrected visual acuity of 20/40 or better. Each patient was assessed before and 7, 30 and 90 days after surgery. Main exclusion criteria were: age less than 18 years old, with previous eye surgery, traumatic cataract, proliferative diabetic retinopathy, any maculopathy, previous retinal laser treatment, use of hormonal or non-hormonal eye drops at least 3 months before surgery. Patients who had posterior capsular rupture during the phacoemulsification were excluded too. Complete ophthalmological exam including biomicroscopy, fundoscopy and intraocular pressure were performed at baseline and at the 7^th, 30^th and 90^th postoperative day. Best corrected visual acuity was performed on the 30^th and 90^th postoperative day using the ETDRS chart. Postoperative topical prednisolone acetate was used in all patients for 5 weeks. OCT was performed on day 7, 30 and 90 after surgery and at baseline whenever it was possible due to the cataract. CMT was used for this analysis.

Results: : 78 eyes of 72 patients were included. Fifty-eight patients were white,13 black and 1 oriental. Thirty-three patients were male. The average age was 68.1 year-old (range, 33-89 year-old). The occurrence of CMT ≥ 250 µm was found in 4 of 78 eyes (5.1%) at day 7, in 12 out of 78 (15.3%) at day 30, and in 6 out of 78 (7.6%) at day 90. From the 12 eyes on the 30th day,11 of them had visual acuity of 20/40 or better. Among the eyes with OCT thickening on the 30^th post-op, 6 eyes persisted with edema, although VA remained ≥ 20/40. Among those 6 eyes which decreased the macular edema between days 30 and 90 post-op, four eyes maintained the BCVA better than 20/40,1 eye had worsening the BCVA than 20/40 and one improved its visual acuity.

Conclusions: : We found at the 30^th day 11 eyes (14.1%) with subclinical macular edema and 1 eye with clinical ME (1.2%) in eyes submitted to uneventful phacoemulsification.

Keywords: retina • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • clinical (human) or epidemiologic studies: prevalence/incidence