Abstract
PurposeThis study compares the presence of vitreous hyper-reflective dots (VHDs) detected with optical coherence tomography (OCT) between eyes with pseudophakic cystoid macular edema (CME) and those with no CME after cataract surgery. In addition, we evaluated the impact of VHDs on the responsiveness of pseudophakic CME to cortisone treatment.SettingDepartment of Ophthalmology, Medical University of Graz, Austria.DesignRetrospective, monocenter case-controlled study.MethodsInclusion criteria for the study group and the control group were CME and no CME within 12 weeks following uneventful phacoemulsification in otherwise healthy eyes, respectively. VHDs (number and size) and the macular thickness were assessed with OCT. Furthermore, the number of peribulbar or intravitreal steroid injections was assessed.ResultsA total of 284 eyes from 267 patients were analyzed, among which 119 met the inclusion criteria for the study (n = 63) and the control group (n = 56). VHDs were observed in 54 (85.7%) study eyes and 21 (37.5%, p = 0.013) control eyes. The number of VHDs was 3.9±3.4 in the study group and 0.7±1 in the control group (p<0.001). The size of the VHDs was 33.5±9.1 μm and 36.6±17.9 μm in the study and control groups, respectively (p = 0.978). Overall, the number of VHDs correlated with central subfield thickness (r = 0.584, p<0.001), cube volume (r = 0.525, p<0.001), and postoperative best-corrected visual acuity (BCVA) (r = -0.563, p<0.001). The number of VHDs did not correlate with the frequency of peribulbar or intravitreal steroid injections.ConclusionVHDs occurred more often in eyes with CME than in eyes without CME following cataract surgery. In addition, the number of VHDs had an impact on the extent of macular thickening and subsequently postoperative BCVA. No correlation was found between the number of VHDs and the frequency of required peribulbar or intravitreal steroid injections.
Highlights
Cystoid macular edema (CME) after uneventful cataract surgery was reported to occur in 0.2– 2.35% of eyes before optical coherence tomography (OCT) was routinely used for its assessment [1,2,3,4]
The number of vitreous hyper-reflective dots (VHDs) had an impact on the extent of macular thickening and subsequently postoperative best-corrected visual acuity (BCVA)
Oh et al detected hyper-reflective dots in the preretinal vitreous of patients who underwent cataract surgery [8]. The nature of these vitreous hyper-reflective dots (VHDs) is unknown; it has been assumed that they originate from lens fragments or represent conglomeration of inflammatory cells, or epithelial cells released from the ciliary epithelium due to surgical trauma or perhaps denatured collagen fibrils [18,19,20,21]
Summary
Cystoid macular edema (CME) after uneventful cataract surgery was reported to occur in 0.2– 2.35% of eyes before optical coherence tomography (OCT) was routinely used for its assessment [1,2,3,4]. Oh et al found a significant relationship between VHDs and pseudophakic CME, which suggests the involvement of VHDs in the postoperative inflammatory process following phacoemulsification [8]. Their conclusions are based on the observation of a significantly higher number of VHDs following cataract surgery in only 10 eyes with CME compared to 62 eyes with no CME after the surgery. The second goal is to evaluate the impact of VHDs on the responsivity of pseudophakic CME to cortisone treatment
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