Abstract
Purpose: :
Assessment of postoperative cystoid macular edema (CME) in aphakic and pseudophakic patients with Boston Type 1 Keratoprosthesis (KPro) using optical coherence tomography (OCT).
Methods: :
The charts of 34 patients who underwent KPro implantation were reviewed for CME. All patients in whom there was clinical suspicion for CME on funduscopic examination underwent OCT imaging. Cystoid macular edema was diagnosed by the presence of foveal effeacement, cystoid spaces, or subfoveal pockets of subretinal fluid. Cystoid macular edema was defined as ‘early’ if within 3 months after surgery, and ‘late’ if greater than 3 months after surgery. Response to treatment was based on follow-up OCT imaging and retinal thickness measurements.
Results: :
Thirty-four patients underwent KPro placement between December 12, 2006 and July 31, 2009. Seventeen (50%) patients were female and 17 (50%) male. The average age at KPro placement was 59.8 (9 mo - 83 yrs). Seven (20.6%) patients had pseudophakic KPro placement, and 27 (79.4%) were aphakic. Twenty-four patients had OCT imaging due to clinical suspicion for CME. Five (14.7%) patients had prominent epiretinal membranes causing macular edema and were excluded in the analysis. Six (17.6%) patients had CME, 5 (83.3%) of which were diagnosed early in the postoperative course. Of patients with CME, 1 (16.7%) had a pseudophakic KPro and 5 (83.3%) were aphakic. All patients with CME had additional procedures at the time of KPro placement. The average number of concurrent procedures in patients with CME was 2.3, as compared to 1.3 in those without CME. Of patients who did not have CME, 6 (26.1%) had pars plana tube shunt (PPT) placement, 3 (13%) had anterior vitrectomy (AV) and 6 (26.1%) had pars plana vitrectomy (PPV). Of patients with CME, 2 (33.3%) had PPT, 4 (66.7%) had AV, and 3 (50.0%) had PPV. Average macular thickness on initial OCT imaging in patients with CME was 563µm. All patients were treated with topical NSAIDS, with or without topical steroids. On last follow-up OCT imaging, average macular thickness was 434 µm.
Conclusions: :
Cystoid macular edema occurs in a significant proportion of patients after KPro surgery. A high index of suspicion should be maintained for CME, particularly in the early postoperative period. Routine OCT imaging is recommended to identify this treatable cause of decreased vision postoperatively.
Keywords: keratoprostheses • macula/fovea