Clinical pseudophakic cystoid macular edema: Risk factors for development and duration after treatment
Accepted 7 May 2007.
Purpose
To characterize the incidence, duration, and risk factors for and outcome of cystoid macular edema (CME) after cataract surgery and investigate the effects of treatment regimens on visual outcome and duration.
This study included 1659 consecutive cataract surgeries performed by residents between 2001 and 2006. Cases were classified according to the presence of CME. Subset analysis excluded patients with diabetes mellitus (DM). The CME groups were analyzed according to type of treatment to compare duration of CME and final best corrected visual acuity.
Results
The incidence of postoperative CME was 2.35% (39/1659), and history of retinal vein occlusion (RVO) was predictive of postoperative CME (odds ratio [OR], 47.12; P<.001). When patients with DM were excluded, the incidence of CME was 2.14% (29/1357) and history of RVO (OR, 31.75; P<.001), epiretinal membrane (ERM) (OR, 4.93; P<.03), and preoperative prostaglandin use (OR, 12.45; P<.04) were predictive of postoperative CME. Patients with DM and/or intraoperative complications did not have an increased risk for CME when treated with prophylactic postoperative nonsteroidal antiinflammatory drugs (NSAIDs) for 3 months. Groups treated with NSAIDs plus a steroid had significantly shorter resolution times than the untreated group (P = .004).
Conclusions
A history of RVO, ERM, and preoperative prostaglandin use were associated with an increased risk for pseudophakic CME. Treatment with NSAIDs plus steroids was associated with faster resolution of CME than no treatment. Treating high-risk patients with NSAIDs after cataract surgery decreases the incidence of postoperative CME to that of patients who are not at high risk.
From the Massachusetts Eye and Ear Infirmary (Henderson, Kim, Ament, Cremers), Harvard Medical School; a private practice (Henderson), and Boston University Medical Center (Ament), Boston; and Mount Auburn Hospital (Ferrufino-Ponce), Harvard Medical School, Cambridge, Massachusetts, USA; Warsaw Medical University (Grabowska), Warsaw, Poland
Corresponding author: Bonnie An Henderson, MD, Ophthalmic Consultants of Boston, 50 Staniford Street, Suite 600, Boston, Massachusetts 02114, USA.
No author has a financial or proprietary interest in any material or method mentioned.
Supported by Research to Prevent Blindness, Massachusetts Lions Foundation, Norman Knight Ophthalmology Fund, Harvard 50th Anniversary Scholars Grant, and Alcon Labs, Inc.
ABSTRACT