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S. Cardone, J.T. Thompson, R.N. Sjaarda; The Role of Pars Plana Vitrectomy for Pseudophakic Cystoid Macular Edema . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3012.
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Purpose: We report the visual outcomes in patients undergoing pars plana vitrectomy for chronic pseudophakic cystoid macular edema recalcitrant to medical therapy and without vitreous incarceration in the cataract wound. Methods: A retrospective analysis was performed on 17 patients who had undergone pars plana vitrectomy for cystoid macular edema resistant to medical therapy. Medical therapy consisted of topical non-steroidal anti-inflammatory drugs, topical corticosteroids, or sub-tenon’s capsule injection of corticosteroids. These patients had cataract extraction by either nuclear expression or phacoemulsification with placement of an intraocular lens. All patients reported worsening visual acuity following cataract surgery, and had evidence of CME by biomicroscopy or angiography. Eyes with vitreous incarceration in the cataract wound, evidence of vitreomacular traction, or comorbid ocular disease contributing to visual loss were excluded. Results: Following vitrectomy, vision improved an average of 3.33 ±4.03 Snellen lines by the time of their final exam (P=.004). The greatest amount of visual improvement for a single eye was 11.0 lines and the greatest loss was –4.00 lines. The mean preoperative visual acuity of all eyes was 20/160 +2, and the final mean acuity following vitrectomy was 20/63 -1. An improvement of >2 lines was seen in 12 of the 17 eyes (71%) at the final follow up visit. In the remaining 5 eyes, 2 showed no improvement while vision worsened in 3. We found no statistically significant correlation between improvement or loss of vision with the choice of medical therapy prior to vitrectomy, nor with the choice of anterior or posterior chamber intraocular lenses. The length of time from cataract extraction to vitrectomy was also not found to correlate with visual outcome. Conclusion: Vitrectomy improves visual acuity in the majority of pseudophakic eyes with chronic cystoid macular edema not responding to medical therapy.
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