Abstract
Purpose :
Cataract surgery is commonly performed in patients with retinitis pigmentosa (RP), but concern exists regarding the possibly heightened risk of postoperative cystoid macular edema (CME). We evaluated the association between RP and postoperative CME after cataract extraction (CE).
Methods :
We analyzed eight years of longitudinal data from the IBM MarketScan® database (2010 – 2018) and included patients aged 18 to 65 years who underwent single-phase CE. We excluded CME and diabetic macular edema cases at baseline. Incident postoperative CME in the same eye that underwent CE was assessed. A mixed-effects Cox model estimated the hazard ratio (HR) and 95% confidence intervals (CI) for the association between CME and RP, controlling for sex, age, diabetes, hypertension, epiretinal membrane (ERM), and retinal vein occlusion. Johns Hopkins University Institutional Review Board approved this project.
Results :
The cohort included 468,123 subjects and 615,645 eyes: 124 with RP and 615,521 without RP. Median follow-up was 9.06 months (95% CI, 9.06 – 9.09). Postoperative CME was reported in 4,933 eyes (0.8%). Subjects with RP had 4.83 times the risk of CME (95% CI, 2.13 – 10.92; P<0.001) than those without RP but with similar characteristics. On average, RP cases developed CME 3.9 weeks later than those without RP (95% Cl, 2.04 – 6.5; P<0.001). In the cohort, baseline ERM was associated with higher risk of postoperative CME (HR, 4.30, 95% CI, 3.12 – 5.93; P<0.001). Age was inversely associated with CME; subjects aged 55 to 65 had 52% lower risk of postoperative CME (95% CI, 39% – 62%; P<0.001) than those aged 18 to 34. However, when stratified by RP status, neither baseline ERM nor age had the same effect in RP eyes. In these subjects, ERM had a protective effect (HR, 0.12; 95% CI= 0.48 – 0.97; P=0.004), and age did not significantly influence the risk, although it had a bimodal distribution.
Conclusions :
Postoperative CME among RP patients may be significantly higher than candidates without RP but otherwise similar characteristics. In addition, CME in RP patients may have a delayed presentation, necessitating longer follow-up. Understanding this risk will facilitate clinician-patient communication regarding treatment recommendations and vision-impacting complications. Future research should focus on interventions to reduce CME risk in RP patients.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.