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Garred Greenberg, Isaac Chocron, Jimmy Lee; Incidence of Post-Cataract Cystoid Macular Edema. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3804.
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© ARVO (1962-2015); The Authors (2016-present)
Pseudophakic cystoid macular edema (PCME) is an important cause of visual impairment after cataract surgery. We sought to determine the incidence of PCME and factors influencing its development.
After IRB review, a retrospective study was performed on a patient cohort that had undergone cataract surgery at an urban academic medical center in 2016 (CPT66984 for standard cataract surgery, CPT66982 for complex cataract surgery). Abstraction was performed using database software and chart review. If a patient had two cases in 2016, each eye was analyzed as a separate case. Cases with additional procedures performed (except anterior vitrectomy), a history of prior eye surgery (except contralateral cataract surgery), or patients not followed at the study site postoperatively were excluded from analysis. PCME was diagnosed by clinical exam or optical coherence tomography.
A total of 2316 cataract surgery cases were analyzed; 2068 (89.3%) cases were standard cataract surgery and 248 (10.7%) were complex. The median patient age was 69 years old (SD = 10.1). There were 1563 (67.5%) female cases, 1118 (48.3%) cases on patients with diabetes mellitus (DM), 21 (0.9%) cases with a history of ipsilateral diabetic macular edema, 18 (0.8%) cases with a history of ipsilateral uveitis, and 21 (0.9%) cases with anterior vitrectomy. Perioperative prednisolone acetate 1% was prescribed in 2311 (99.8%) cases; perioperative ketorolac was prescribed in 1710 (73.8%) cases, always in addition to prednisolone acetate 1%. PCME incidence was 1.7% (N=39). Subgroup analysis showed a PCME incidence of 3.2% in the complex surgery subgroup (p=0.05), 1.5% in the DM subgroup (p=0.56), 5.6% in the uveitis subgroup (p=0.20), and 1.5% in the ketorolac subgroup (p=0.30). In patients with DM, cases with only perioperative prednisolone acetate 1% had a PCME rate of 2.1%, compared to 1.4% when also prescribed ketorolac (p=0.38). Of the patients who developed PCME, 4 (10.3%) had an intraoperative surgical complication. Univariate logistic regression showed that ketorolac was protective against PCME (odds ratio [OR], 0.70; p=0.31), while complex surgery (OR, 2.19; p=0.05) and uveitis (OR, 3.50; p=0.23) were risk factors.
The incidence of PCME in our patient population was 1.7%. PCME develops over twice as frequently in complex cases than standard cases.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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