Abstract
Background: To evaluate the clinical course of pseudophakic cystoid macular edema (PCME) treated with topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: An analysis of the clinical course of PCME consisting of 536 eyes of 536 patients from five consecutive randomized clinical trials aimed at the optimization of anti-inflammatory medication in patients undergoing routine cataract surgery. PCME was classified as (i) grade 0a; no macular thickening, (ii) grade 0b; macular thickening (central subfield macular thickness (CSMT) increase of at least 10%) without signs of macular edema, (iii) grade I; subclinical PCME, (iv) grade II; acute PCME, (v) grade III; long-standing PCME. Eyes with PCME classification from grade I onwards were treated with nepafenac 1 mg/mL t.i.d. for two months. Results: CSMT increase of at least 10% at any postoperative timepoint with cystoid changes—a criterion for PCME—was found in 19 of 536 eyes (total incidence 3.5%). Of these 19 eyes, 13 eyes (total incidence 2.4%) had clinically significant PCME. PCME was considered clinically significant when both of the following visual acuity criteria were fulfilled. At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals. Only one of the 19 eyes with criteria for PCME (total incidence 0.2%, incidence of PCME eyes 5.3%) showed no macular edema resolution within 2 months after topical nepafenac administration. Conclusions: PCME in most cases is self-limiting using topical nepafenac without any further need for intravitreal treatment.
Highlights
The reported incidence of pseudophakic cystoid macular edema (PCME) varies greatly depending on the methods used to identify it, and the diagnostic criteria used to classify its occurrence after cataract surgery
Prostaglandin analogs (PG) in the treatment of glaucoma are suspected to cause a higher incidence of PCME [12], but the evidence is debated as other studies have failed to recognize preoperative prostaglandin analogs (PG) use as a risk for PCME [3,7]
At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals
Summary
The reported incidence of pseudophakic cystoid macular edema (PCME) varies greatly depending on the methods used to identify it, and the diagnostic criteria used to classify its occurrence after cataract surgery. Diabetes [1,3,4,5,6,7,8], uveitis [1,9], epiretinal membrane [1,7,10], prior history of macular hole and contralateral PCME [7], retinal vein occlusion [3,7], intraoperative capsule rupture with or without vitreous loss, and intraoperative iris manipulation [3,11] are known to increase the incidence of PCME. In patients with diabetes, transient corneal edema was found to be predictive for PCME development [13]
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