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Risk of Pseudophakic Cystoid Macular Edema in Fellow-Eye Cataract Surgeries
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To quantify the risk of pseudophakic cystoid macular edema (pCME) in fellow-eye cataract surgery, and to determine risk factors, including prior first-eye pCME.
Retrospective clinical database study PARTICIPANTS: Patients undergoing bilateral non-simultaneous cataract surgeries in eight United Kingdom National Health Service clinical centers between July 2003 and March 2015.
We excluded patients with history of diabetic macular edema and perioperative topical non-steroidal anti-inflammatory drug use in either eye. We calculated the overall risk of pCME and used multiple log-binomial regression to calculate adjusted relative risks of pCME in the fellow eye for potential risk factors.
MAIN OUTCOME MEASURE
The risk of postoperative clinical pCME in the fellow eye RESULTS: A total of 54,209 patients were included. The mean age was 74.6 ± 10.4 years and 38.8% were males. The fellow-eye developed pCME in 544 (1%) patients. The risk of fellow-eye pCME among patients without first-eye pCME was 0.9%. However, the risk among those with first-eye pCME was 10.7%. In the fully adjusted model, we found that the risk factors for the development of fellow-eye pCME were first-eye pCME (RR = 8.55, 95% confidence interval [CI] = 6.19 - 11.8), epiretinal membrane (RR = 4.1, CI = 2.63- 6.19), history of retinal vein occlusion (RR = 2.94, CI = 1.75 - 4.93), diabetes without history of DME (RR = 2.08, CI = 1.73 - 2.5), advanced cataract (RR = 1.75, CI = 1.16 - 2.65), prostaglandin analogue use preoperatively (RR = 1.49, CI = 1.13 - 1.97), and male sex (RR = 1.19, CI = 1.0 - 1.41).
History of pCME in one eye is the strongest independent risk factor for development of pCME in the fellow eye. Our findings may guide clinicians in counselling patients on the risk of pCME prior to performing in cataract surgery in the fellow eye and help in identifying high-risk patients who may benefit from prophylactic therapy.
Risk of Pseudophakic Cystoid Macular Edema in Fellow-Eye Cataract Surgeries: A Multicenter Database StudyOphthalmology 2023 Feb 03;[EPub Ahead of Print], AF Shakarchi, MK Soliman, YC Yang, AB Sallam
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
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This article is a large retrospective clinic database review of patients who underwent bilateral nonsimultaneous cataract surgery in eight clinical centers in the United Kingdom National Health Service over a 12-year period. The goal of the study was to quantify the risk of pseudophakic cystoid macular edema (pCME) within 90 days of surgery and determine the associated risk factors. They evaluated 54,209 patients. Patients with a history of cystoid or diabetic macular edema, preoperative or postoperative use of topical nonsteroidal anti-inflammatory drugs, or simultaneous cataract surgery were excluded.
The study found an overall rate of pCME of approximately 1%, consistent with previous studies. Patients who had pCME in the first eye were more likely to be male, to have diabetes, epiretinal membrane, a history of uveitis, a history of retinal vein occlusion, high myopia, previous retinal detachment repair, and posterior capsule rupture. The risk factors for pCME in the second eye were having pCME in the first eye, epiretinal membrane, a history of retinal vein occlusion, diabetes, advanced cataract, preoperative prostaglandin use, and male gender.
The strongest risk factor for pCME in the second eye was having pCME in the first eye, with more than eight times higher risk. Anecdotally, this is consistent with my experience. The mean duration between surgery and diagnosis of pCME was almost 6 weeks, which is significantly longer than the typical 2 to 4 weeks between the first and second eye cataract surgery in the United States. For this reason, it is also important to consider the other risk factors identified in this study when determining which patients require prophylactic treatment to prevent pCME. In patients who are already at higher risk, it may be prudent to recommend a longer gap between surgeries.