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Robert Hoerster, Carl von Netzer, Leonie Schulze, Jonas Obstmayer, Erdal Tahmaz, Ludwig M Heindl; Glaucoma as a risk factor for early pseudophakic macular edema – an analysis of 1000 cataract surgeries. Invest. Ophthalmol. Vis. Sci. 2019;60(9):499.
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© ARVO (1962-2015); The Authors (2016-present)
Pseudophakic Cystoid Macular Edema (PCME) is a frequent complication after cataract surgery, occurring in 1 to 5% of all cases. Recent reports have described Diabetic Retinopathy (DR) among other as a risk factor for PCME and that in DR-patients preoperative therapy with non-steroidal anti-inflammatory drugs (NSAIDs) can be beneficial. Controversy exists concerning Open Angle Glaucoma (OAG) as an independent risk factor for PCME. We here aimed to analyze OAG and other possible risk factors for early PCME.
We prospectively enrolled patients receiving cataract surgery at a tertiary referral center (MVZ ADTC Moenchengladbach/Erkelenz, Erkelenz, Germany) between 2017/07 and 2018/07. Preoperatively all patients received spectral-domain optical coherence tomography (SD-OCT). Patients were followed weekly for the first month. Postoperatively, we performed SD-OCT in all cases of best corrected visual acuity lower than 0.8 Snellen decimal (20/25 foot). We compared medical history data, intraoperative and postoperative complications of patients with and without early PCME.
We enrolled 1000 eyes of 738 patients. 32 eyes of 30 patients (3.2%) developed PCME during follow up. In patients with PCME we found increased incidence of DR (12.5 vs. 3.5%, P=0.030), of preoperative epiretinal membranes (15.6 vs. 5.2%, P=0.027) and of OAG 18.8 vs. 7.5%, P=0.037). All patients with OAG and PCME received prostaglandine (analogues) vs. 77% with OAG and no PCME (P=0.331). None of the PCME patients with OAG had received glaucoma surgery previously. We also found a tendency to posterior capsule rupture (6.3 vs. 1.2%, P=0.070) and postoperative sterile inflammation (9.4 vs. 2.9%, P=0.067).
The incidence of PCME in our cohort is comparable to that, reported in the literature. Intraoperative trauma, as well as pre- or postoperative impairment of the blood-retinal barrier, as in DR and sterile inflammation, seems to promote PCME. OAG seems to be a risk factor for PCME of its own. In our cohort we found no increased frequency of prostaglandine (analogues) in PCME cases. Preoperative prophylactic treatment of OAG patients with NSAIDs therefore seems worthwhile.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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