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M.-L. Belair, S. J. Kim, J. E. Thorne, D. M. Brown, J. P. Dunn, S. R. Kedhar, D. A. Jabs; Analysis of Cystoid Macular Edema After Cataract Surgery in Patients With and Without Uveitis Using Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5143.
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Cataract formation is common in uveitis, and cystoid macular edema (CME) is a well-recognized structural complication of uveitis and of cataract surgery. CME is a cause of visual loss in patients with uveitis after cataract surgery. Optical coherence tomography (OCT) provides high-resolution cross-sectional imaging that directly measures retinal thickness. Incidence of CME in patients with uveitis after cataract surgery using OCT has not been defined. The objectives were to: 1) Compare the incidence of CME after cataract surgery between patients with and without uveitis using OCT. 2) Assess the incidence of CME after cataract surgery in patients with uveitis using OCT and correlate this with the type of uveitis and other known risk factors.
Study participants consisted of a consecutive cohort of patients undergoing cataract surgery with uveitis and without uveitis (control group). A total of 41 eyes with uveitis and 52 eyes without uveitis were enrolled in the study. Clinical examination and OCT testing were performed no more than 4 weeks prior to the date of surgery and on the 1-month and 3-month post-operative visits. The main outcome was incidence of CME at 1 and 3 months, and secondary outcomes were changes in foveal thickness, as detected on OCT, and visual acuity.
Mean pre-operative visual acuity was 0.41 LogMAR (20/50) for the uveitis group and 0.38 LogMAR (20/50) for the control group. At the 1-month post-operative visit, mean visual acuity was 0.13 LogMAR (20/30) for the uveitis group and 0.07 LogMAR (20/25) for the control group. At the 3-month post-operative visit, mean visual acuity was 0.11 LogMAR (20/25) for the uveitis group and 0.04 LogMAR (20/20) for the control group. The incidence of CME at 1 month after cataract surgery was 12% in the uveitis group and 4% in the control group (RR = 3.11, p=0.24, FET). The incidence of CME at 3 months after cataract surgery was 8.3% in the uveitis group and 0% in the control group. In the uveitis group, the incidence of CME at 1 month after cataract surgery for eyes treated with pre-operative oral corticosteroids was 3.8% compared to 27% for eyes not treated with pre-operative oral corticosteroids (RR=0.14, p=0.05, FET).
Our data suggest an increase rate of CME in patients with uveitis at 1 and 3 months after cataract surgery compared to patients without uveitis. Among eyes with uveitis, pre-operative treatment with oral corticosteroids appeared to have a statistically significant protective effect against development of CME at one month after cataract surgery.
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