Abstract
Purpose :
Pseudophakic cystoid macular edema (CME) is a well-recognised and potentially serious postoperative complication after cataract surgery. We aim to explore the risk factors of post-phacoemulsification CME including unilateral and bilateral eyes in an ethnically diverse population.
Methods :
A retrospective study of patients undergoing phacoemulsification cataract surgery between 2017 and 2022 at 3 London hospital sites. The analysed outcome variable was post-phacoemulsification CME confirmed on optical coherence tomography. Risk factors for unilateral versus bilateral CME cases were evaluated. Statistically significant factors in univariate analysis were entered into a logistic regression model to identify factors for risk of CME.
Results :
Of the 3442 eyes eligible for analysis, 102 (3%) developed CME. The median age of patients was 69 years with a range of 40-93 in eyes with CME. 953 patients had bilateral surgery. Univariate factors identified for CME were Mixed/Others ethnicity, fellow eye CME, other macular pathology, epiretinal membrane (ERM), and posterior capsular rupture (PCR), but not diabetes. Contingency table testing identified a statistically significant higher proportion of patients with bilateral CME (1.4%) versus unilateral CME in the first operated eye (0.9%) or second operated eye (0.7%) (p<0.001, x2=216.38). The logistic regression model identified that Mixed/Others ethnicity and other macular pathology were non-significant (p>0.05), but CME in the fellow eye (OR 71.93, 95%CI 36.67-141.09, p<0.001), ERM (OR 13.38, 95%CI 2.24-80.02, p=0.004), and PCR (OR 5.28, 95%CI 2.19-12.72, p<0.001) were independently associated with a higher incidence of CME. The data of patients with bilateral CME were re-evaluated to identify other factors to account for this finding and none were found.
Conclusions :
The occurrence of CME in the first eye is associated with a higher risk of CME in the second eye. The risk of developing bilateral CME is independent of PCR, ERM, other ocular comorbidities, intraoperative complications, and systemic risk factors such as diabetes. The reason for this is unknown. Our results suggest that clinicians should consider amending perioperative management of second eye surgery to prevent occurrence of CME if it has occurred in the first eye.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.