Abstract
Purpose :
Cystoid macular edema (CME) is a known complication of cataract surgery, which may lead to decreased visual acuity. This cross-sectional study examines the potential association between micro-invasive glaucoma surgery (MIGS) and CME in glaucoma patients undergoing cataract surgery in the California (CA) Medicare population.
Methods :
The 2019 CA Master Beneficiary Summary File and 2019 Standard Analytic Files of Part B Carrier Claim data files from the Centers for Medicare and Medicaid Services were used to identify beneficiaries ≥65 years old with open-angle glaucoma (OAG) and cataract surgery. The outcome of interest was CME. Patients with MIGS were defined as those with procedure codes for trabecular microbypass iStent, goniotomy/canaloplasty, XEN subconjunctival gel stent, or cyclophotocoagulation. Chi-squared tests were performed to evaluate univariable associations between MIGS and CME in the study population. Logistic regression was used to assess multivariable associations between MIGS and CME, adjusting for age, sex, race/ethnicity, Charlson comorbidity index, diabetic retinopathy, and retinal vein occlusion.
Results :
In 2019, 12,755 CA Medicare beneficiaries with OAG underwent cataract surgery, of whom 6,157 (48.3%) received MIGS. The largest proportion were female (7,118, 55.8%) and White (7,221, 56.6%). Of the 6,157 patients with cataract surgery and MIGS, there were 4,013 (65.2%) with trabecular microbypass iStent, 2,158 (35.0%) with goniotomy/canaloplasty, 94 (1.5%) with XEN subconjunctival gel stent, and 476 (7.7%) with cyclophotocoagulation. CME was not statistically significantly associated with any MIGS in the total study population (odds ratio [OR]=0.92, 95% CI 0.80-1.06) or in diabetic patients (OR=0.89, 95% CI 0.71-1.11). Compared to OAG patients with cataract surgery alone, those with goniotomy/canaloplasty had increased odds of CME in the adjusted analyses (unadjusted OR=1.15, 95% CI 0.96-1.39, adjusted OR=1.25, 95% CI 1.03-1.51), while those with trabecular microbypass iStent had lower odds of CME in unadjusted but not adjusted analyses (unadjusted OR=0.80, 95% CI 0.68-0.95, adjusted OR=0.86, 95% CI 0.72-1.02).
Conclusions :
Amongst 2019 CA Medicare beneficiaries with OAG receiving cataract surgery, use of MIGS overall was not associated with increased risk of CME. However, goniotomy/canaloplasty may be associated with increased likelihood of CME, which requires further evaluation.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.