Cystoid macular edema after cataract surgery with intraocular vancomycin

Abstract

Objective To determine whether the use of supplemental prophylactic vancomycin in the irrigating solution during extracapsular lens extraction is associated with increased incidence of cystoid macular edema. Design Prospective, randomized, double-masked clinical study. Participants Consecutive series of 118 patients 60 years of age or older undergoing cataract surgery. Intervention The study group received an irrigating balanced salt solution supplemented with vancomycin (10 μg/ml), and the control group received the salt solution only. Fluorescein angiography was performed 1 and 4 months after surgery. Main outcome measures Evidence of angiographic and clinical cystoid macular edema, and visual acuity at 1 and 4 months after surgery. Results The rate of postoperative angiographic cystoid macular edema was significantly higher in the study patients than in the control group at 1 month (55% vs. 19%, P = 0.0006) and 4 months (26% vs. 4%, P = 0.0099). The rates of clinical macular edema were 23% and 7%, respectively, at 1 month ( P = 0.011) and 20% versus 0% at 4 months ( P = 0.006). Visual acuity of 20/30 or better was noted at 4 months after surgery in 76% of the study group compared to 95.5% of the control group. Conclusions The role of preventive intracameral vancomycin during intraocular surgery should be reassessed in view of the associated increase in the incidence of angiographic cystoid macular edema.