Pseudophakic Cystoid Macular Edema Research Articles

FREQUENCY OF CYSTOID MACULAR EDEMA ON OPTICAL COHERENCE TOMOGRAPHY IN TWO DIFFERENT TYPES OF CATARACT SURGERY

Cystoid macular edema (CME), also known as Irvine-Gass syndrome, has been recognized as a non-specific manifestation of various ocular conditions, with cataract surgery being a significant contributing factor. First reported by Sir Irvine in 1953 and further discussed by Sir Norton in 1966, CME following cataract surgery remains a topic of interest and concern in ophthalmology. The precise etiology of CME in post-cataract surgery patients remains elusive; however, it is widely accepted that post-surgical inflammation plays a pivotal role. To address this issue, we conducted a comparative study to assess the frequency of CME using spectral-domain optical coherence tomography (SD-OCT) in patients undergoing extracapsular cataract extraction (ECCE) versus phacoemulsification cataract surgeries. The study was conducted at the Department of Clinical Ophthalmology, Khyber Institute of Ophthalmic Medical Sciences; Medical Teaching Institute Hayatabad Medical Complex, Peshawar, over a period of 6 months. Utilizing a randomized controlled trial design and non-probability consecutive sampling, we determined a sample size of 70 patients, with 35 patients allocated to each group (Group A: ECCE, Group B: Phacoemulsification). The age of the participants ranged from 50 to 85 years, with a median of 60 years and a mean of 65±8 years. Our findings revealed that CME was observed in 11% of patients in Group A and 6% in Group B, indicating a lower frequency in post-operative cases. However, the difference in CME incidence between ECCE and phacoemulsification cases was not statistically significant. These results suggest that the risk of CME in post-operative cases may be influenced by various factors, including surgical technique and patient-specific variables. In conclusion, our study contributes to the understanding of CME following cataract surgery and underscores the importance of continued vigilance and further research in this area. Improved surgical techniques and perioperative management may help mitigate the risk of CME and enhance patient outcomes in the postoperative period.

2 Year results of combined phacoemulsification‐ iStent inject W, from a single centre

Aims/Purpose: Our aim is to review the 2 year results of combined phacoemulsification and iStent inject W implantation in a single centre in East London.Methods: Patients were listed for surgery when cataract surgery was needed and further control of glaucoma was necessary. Electronic medical records were reviewed of all the patients who underwent the procedure in the period ranging from May 2018 until February ‘21. 87 eyes of 77 patients were identified, 3 eyes were lost to follow up in year one and 2 year data were obtained for 17 eyes. Vision, iop, drop dependency was measured and complications were recorded. Further surgical treatment was considered failure and the patient was then removed from the cohort.Results: Mean vision improved from LogMAR 0,45 to 0,16 stable throughout the two years. Drop dependency dropped modestly from 2,71 to 2,49 (8%) in year one and 2,35% (13,04%) in year two. IOP dropped from 19,25mHg to 14,55 mmHg (24,43%) in year one and 12,41 mmHg (36,68%) in year two. Complications included one patient with retained lens matter, 1 with recurrent uveitis, 1 iris prolapse, 1 Irvine Gass syndrome,1 had steroid response and 2 had pressure spikes. Furthermore by year 2, 1 patient was excluded due to incomplete documentation, 2 were discharged, 4 died (6 eyes), 4 patients needed further treatment with trabeculectomy and one received micropulse cyclodiode laser.Conclusions: Overall combined phacoemulsification/iStent inject W surgery is safe, effective, does not affect the overall safety profile of phacoemulsification surgery and has a place in early and moderate glaucoma. Improvement in year 2 results in comparison to year one can be explained by the removal from the study of the patients that received further treatment; and the small number of patients seen is an effect of the reduced capacity because of the COVID‐19 pandemic restrictions during that time.

Cystoid macular edema after vitrectomy and after phacovitrectomy for epiretinal membrane

ObjectiveTo compare the incidence of cystoid macular edema (CME) after vitrectomy and CME after phacovitrectomy in patients requiring epiretinal membrane (ERM) removal. DesignA retrospective, comparative, interventional study. MethodsMedical records of patients who had undergone vitrectomy or phacovitrectomy for ERM removal by a single surgeon were retrospectively reviewed. Phacovitrectomy was performed in all phakic eyes and vitrectomy was performed in all pseudophakic eyes. Increased macular thickness (IMT) was defined as an increase in macular thickness by more than 10% at the postoperative week 4 visit compared to the measurements at baseline. ResultsThere were 214 and 53 eyes in the Phacovitrectomy group and the Vitrectomy group, respectively. IMT occurred in 15.4% of the Phacovitrectomy group, which was higher than the incidence of 3.8% in the Vitrectomy group (p=0.023). ConclusionsIMT, that is suspected to be a type of CME, was not uncommon (15.4%) after phacovitrectomy in phakic eyes but was uncommon (4.8%) after vitrectomy alone in pseudophakic eyes. Irvine-Gass syndrome appears to be triggered by crystalline lens removal itself rather than intraocular surgery or surgical trauma alone.

The effects of non-prostaglandin hypotensive drops with preservative on central retinal thickness after phacoemulsification

BACKGROUND: Primary open angle glaucoma is often associated with cataract. The correlation between the use hypotensive drops, in particular non-prostaglandin hypotensive drops with preservative, and the change in central retinal thickness after phacoemulsification with intraocular lens implantation continues to be relevant.
 AIM: To evaluate central retinal thickness and pseudophakic cystoid macular edema incidence after phacoemulsification with intraocular lens implantation in patients with primary open-angle glaucoma using non-prostaglandin hypotensive drops with preservatives.
 MATERIALS AND METHODS: 94 patients (108 eyes) with cataract were enrolled in the study, divided into 3 groups: the first group 21 patients (27 eyes), and the second group 21 patients (23 eyes) with primary open-angle glaucoma using non-prostaglandin hypotensive drops with preservative; the third (control) group included 52 patients (58 eyes) without ocular comorbidities. All patients underwent uncomplicated phacoemulsification with intraocular lens implantation. In the post-op period, patients of the first group received topical antibiotics and steroids, patients of the second and the third groups received the same treatment and non-steroidal anti-inflammatory drops as well. Central retinal thickness was measured using optical coherence tomography before surgery, 2 weeks, 2 and 6 months after surgery.
 RESULTS: The central retinal thickness increase in comparison with baseline values was more significant in the first group than in the second and the third groups, and the time of recovery to baseline values during 6 months after surgery was longer. Pseudophakic cystoid macular edema was not identified in any group.
 CONCLUSIONS: The use non-prostaglandin drops with preservative in patients with primary open-angle glaucoma does not affect pseudophakic cystoid macular edema development after uncomplicated phacoemulsification. Instillations of non-steroidal anti-inflammatory drops in the post-op period reduce the time of central retinal thickness recovery to baseline value.

Observation of the Curative Effect of the Dexamethasone Vitreous Cavity Implant for the Treatment of Irvine-Gass Syndrome

ObjectiveTo investigate the clinical efficacy of dexamethasone vitreous cavity implants (Ozurdex) for the treatment of macular edema (Irvine-Gass Syndrome) after cataract surgery. MethodEight patients (eight eyes) with Irvine-Gass syndrome were enrolled for vitreous injections with Ozurdex. The patients included six men (six eyes) and two women (two eyes) with a mean age of 67.12 ± 11.92 years. Changes in the patients best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure were compared before and after treatment. ResultThe mean visual acuity BCVA of the patients was 0.81 ± 0.26 before implantation, which improved to 0.20 ± 0.12, 0.13 ± 0.09, and 0.15 ± 0.13 at 2 weeks, 1 month, and 3 months after implantation, respectively (P < 0.001). The patient’s mean CMT before implantation was 703.00 ± 148.88 μm, and it reduced to 258.87 ± 37.40 μm, 236.25 ± 28.74 μm, and 278.00 ± 76.82 μm at 2 weeks, 1 month, and 3 months after implantation, respectively (P < 0.001). ConclusionThe dexamethasone vitreous cavity implant (Ozurdex) is a safe and effective treatment, which can effectively improve patient’s visual acuity and reduce macular edema associated with cataract surgery.

Review of Risk Factors and Complications of Anterior Migration of Ozurdex Implant: Lessons Learnt from the Previous Reports.

Purpose: Ozurdex had shown promising anatomical and functional outcomes in managing refractory Irvine-Gass syndrome over the years. Burgeoning usage of Ozurdex has prompted the study of its related complications, particularly the anterior chamber migration of the implant. Methods: Literature reviews on the anterior chamber migration of the Ozurdex via PubMed, EBSCO, and TRIP databases were searched from 2012 to 2020. The predisposing factors, outcomes, and management of such cases were evaluated. Results: A total of 54 articles consisting of 105 cases of anterior migration of Ozurdex were included in this analysis. The vitrectomized eye and compromised posterior capsule were highly associated with this complication. About 81.9% of the cases had cornea edema upon presentation, with 31.4% of them ending up with cornea decompensation despite intervention. Although there was high intraocular pressure reported initially in 22 cases, only 2 cases required glaucoma filtration surgeries in which they had preexisting glaucoma. Numerous techniques of repositioning or surgical removal of the implant were described but they were challenging and the outcomes varied. Conclusions: A noninvasive method of manipulating the Ozurdex into the vitreous cavity via the "Trendelenburg position, external pressure with head positioning" maneuvers is safe yet achieves a favorable outcome. Precaution must be taken whenever offering Ozurdex to the high-risk eyes. Prompt repositioning or removal of the implant is crucial to deter cornea decompensation. Clinical Trial Registration number: NMRR-22-02092-S9X (from the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia).

Correlation between Severity of Idiopathic Epiretinal Membrane and Irvine-Gass Syndrome.

A higher risk of pseudophakic cystoid macular edema (PCME) has been reported in patients with preoperative idiopathic epiretinal membrane (ERM); however, whether the formation of PCME depends on the grade of ERM has not been well established. We conducted a retrospective case-control study of 87 eyes of 78 patients who were preoperatively diagnosed with idiopathic ERM and had undergone cataract surgery. Patients were divided into two groups: PCME and non-PCME groups. After cataract surgery, the ERM status was graded using the Gass and Govetto classifications. Both the central macular thickness (CMT) and ERM grade increased after surgery, and higher preoperative CMT and ERM grades were found in the PCME group. The association between higher-grade ERM and the development of PCME was significant in the Govetto classification (grade 2, odds ratio (OR): 3.13; grade 3, OR: 3.93; and grade 4, OR: 16.07). The study results indicate that close attention should be given to patients with ERM with the presence of an ectopic inner foveal layer before cataract surgery.

Bilateral effect following off label unilateral intravitreal brolucizumab injection in patient with pseudophakic cystoid macular edema.

To report a bilateral reduction in pseudophakic cystoid macular edema (PCME) after unilateral intravitreal injection (IVI) of brolucizumab. A 64-year-old female with bilateral recalcitrant PCME was treated with one dose of intravitreal ozurdex implant and triamcinolone acetonide each in both the eyes, with an equivocal response. On switching to IVI brolucizumab in the right eye (OD), the patient showed significant improvement in the best-corrected visual acuity (BCVA) with a notable reduction in the intraretinal fluid (IRF) and central subfield thickness (CST) in both the eyes at one month. In conclusion, IVI brolucizumab is effective for the management of recalcitrant PCME with good visual and anatomical outcomes at one month. However, this molecule can also have therapeutic efficacy in the uninjected eye possibly due to systemic escape. More research into the pharmacokinetic properties of this novel molecule is needed to validate our findings.

Dexamethasone intravitreal implant for macular edema and some other rare indications in uveitis.

In the present study, 110 eyes of 81 patients with uveitis who underwent intravitreal dexamethasone implant (IDI) injection and had a follow-up of at least 6 months between January, 2012 and September, 2022, were retrospectively analyzed. A total of 298 IDI injections were administered (mean, 2.71±2.37; range, 1-12). The mean age of the patients was 49.44±16.67 years (range, 15-86 years). The mean follow-up time after the first IDI was 34.31±26.53 months (range, 6-115 months). In total, 77 (95.1%) patients had non-infectious uveitis, while 4 patients (4.9%) received IDI for uveitic macular edema in association with infectious uveitis (1 patient with acute retinal necrosis and 3 patients with systemic tuberculosis). IDI was injected under the umbrella of intravitreal ganciclovir injection in the patient with healed acute retinal necrosis for the associated pseudophakic cystoid macular edema. A total of 6 patients (7.4%) received IDI prior to phacoemulsification surgery to control the possible post-operative macular edema. In addition, 3 patients (3.7%) with Vogt-Koyanagi-Harada disease received bilateral IDI as the systemic therapy could not be administered due to side-effects of the systemic treatment. In total, 1 patient (1.2%) with idiopathic retinal vasculitis, aneurysms and neuroretinitis was treated with IDI injections in both eyes in addition to systemic therapy to reduce the ongoing inflammation. Of note, two eyes (1.8%) received simultaneous single IDI and anti-vascular endothelial growth factor administration for the treatment of unilateral extrafoveal macular neovascularization (one with active serpiginous choroiditis and one with sympathetic ophthalmia). IDI was administered for the treatment of uveitic macular edema in 68 patients (83.9%). Best-corrected visual acuity improved from 0.69±0.64 to 0.60±0.76 logMAR at the final visit (P=0.008). Baseline mean central macular thickness (CMT) was 499.74±229.60 µm (range, 187-1,187 µm) and the mean final CMT was 296.60±152.02 µm (range, 126-848 µm). Intraocular pressure elevation requiring topical antiglaucomatous eye drops occurred in 28 eyes (25.5%). During the follow-up period, bilateral glaucoma surgery was required in 1 patient (1.2%) and 25 of 65 phakic eyes (38.4%) underwent phacoemulsification. Retinal detachment occurred in one eye (0.9%), endophthalmitis in one eye (0.9%), and transient intravitreal hemorrhage occurred in three eyes (2.7%) after the IDI injections. On the whole, the present study demonstrates that although IDI is mostly employed in non-infectious uveitic eyes with macular edema, it can also be administered in cases with systemic therapy intolerance, pseudophakic macular edema prophylaxis, and with great caution, in selected cases involving infectious uveitis and macular edema.

The efficacy of different anti-vascular endothelial growth factor agents, and dexamethasone implant therapy in patients with serous retinal detachment caused by Irvine-Gass syndrome.

The aim of this study is to compare the efficacy of intravitreal aflibercept (IVA), bevacizumab (IVB), ranibizumab (IVR), and dexamethasone implant (IVDI) in the treatment of serous retinal detachment (SRD) caused by Irvine-Gass syndrome (IGS). Retrospective cohort, comparative study. The medical records of 128 eyes with no previous history of intravitreal agents in 128 IGS patients with SRD that received IVA, IVB, IVR, and IVDI monotherapy were retrospectively reviewed. The patients were divided into 4 groups, according to treatment. Patients with recurrence and/or were unresponsive following a course of topical steroids and non-steroidal anti-inflammatory drugs (NSAIDs) were included in the study. Best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and SRD were compared between the 4 treatment groups at baseline, at follow-up months 1, 3, 6, and 12, and at the final follow-up visit. Serous retinal detachment completely resolved in 74%, 45.7%, 66.4%, and 40.8% of the eyes at month 1 (P = 0.042), 87%, 50.9%, 75.8%, and 80.9% at month 3 (p = 0.031), 88.9%, 50.4%, 75.7%, 80.2% at month 6 (p = 0.028), 81.7%, 72.8%, 68.7%, 80.1% at month 12 (p = 0.580), and 100%, 66.4%, 87.9%, 93.2% (p = 0.478) at final follow-up visit in the IVA, IVB, IVR, and IVDI groups, respectively. BCVA was significantly better in the IVA group at all follow-up time points (month 1: p < 0.001; month 3: p < 0.001; month 6: p = 0.002; month 12: p = 0.009, final follow-up visit: p < 0.001). CMT was significantly lower in the IVA group at months 3 (p = 0.008), 6 (p = 0.011), and 12 (p = 0.010), and at the final follow-up visit (p < 0.001). Recurrence was observed after a longer period of time and fewer injections were needed in the IVDI and IVA groups (p < 0.05). Resolution of CME was most rapid in the IVA group (p = 0.032). All intravitreal agents were effective in terms of visual results in the SRD patients; however, eyes treated with IVA and IVDI required fewer injections, as compared to the eyes treated with IVB and IVR. Furthermore, SRD entirely resolved in all eyes in the IVA group at the final follow-up visit.

Topical nonsteroidal anti-inflammatory drugs in the prevention of pseudophakic cystoid macular edema following phacoemulsification: A systematic review

Introduction: The goal of surgeons to avoid Pseudophakic Cystoid Macular Edema (PCMO) has led to the widespread use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) after cataract surgery, although current research into the best anti-inflammatory drugs to avoid PCMO is still underway. This review aimed to determine the efficacy of topical NSAIDs in preventing PCMO following phacoemulsification. Methods: This systematic review was built on the recommended reporting items for systematic reviews and meta-analyses (PRISMA) and PICO criteria for papers during the previous 10 years. The keywords was searched by Boolean operator: “NSAIDs” AND “Prevention” AND “Cystoid Macular Edema” AND “Optical Coherence Tomography” AND “Phacoemulsification”. According to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist, the quality of each chosen article was evaluated. Results: We have selected five articles of prospective cohort studies, which involved 756 patients whom received topical NSAIDs (Nepafenac 0.3%, Ketorolac Tromethamine 0.4%Nepafenac 0.1%, , and Diclofenac 0.1%) in treatment group and 700 patients received Placebo (Artificial tears) in control group. There was significant difference of central macular thickness based on OCT results between NSAIDs and control (placebo) group after uneventful phacoemulsification. Additionally, NSAIDs used as a preventative before phacoemulsification procedure exhibited a significantly reduced rise in central foveal thickness compared to placebo. There were changes of central macular thicknes postoperatively, and were significantly different from preoperative. Conclusion: It has been demonstrated that topical NSAIDs successfully lower the incidence of Pseudophakic Cystoid Macular Edema following phacoemulsification.

Irvine-Gass Syndrome: Clinical, Therapeutic and Progressive Aspects (A Series of 100 Eyes)

Postoperative macular oedema (MO), better known as Irvine-Gass syndrome, remains an important cause of visual acuity loss (VAL) after cataract surgery. Macular oedema (MO) is a thickening of the macular retina due to the accumulation of fluid and proteins in retinal tissue. Irvine Gass syndrome is a type of MO that can complicate cataract surgery. The frequency of occurrence of Irvine-Gass is significantly increased in case of capsular rupture or diabetic, uvetic context surgery or a history of venous occlusion. This is a descriptive study involving 100 eyes operated on for cataracts by phacoemilification in the adult ophthalmology department of the Avicenne Marrakech Military Hospital. The purpose of this work is to study the epidemiological profile, clinical, paraclinical, therapeutic and evolutionary aspects of MO after phacoemulsification.

Optical Coherence Tomography-guided intravitreal bevacizumab in the treatment of refractory pseudophakic cystoid macular edema – case study

One of the serious vision threatened complications of cataract surgery is refractory PCME. That is why this complication has to be managed in time and adequately. Non steroidal and steroidal antiinflammatory and anti VEGF agents like bevazicumab are useful for refractory PCME. OCT has an important role in detecting PCME and measurement of central macular thickness to control the treatment of PCME. In this case study patient after rutin uncomplicated FACO surgery with refractory PCME at postop 4-th week is described. Despite of using of topical NSAID+steroidal antiinflammatory treatment there was no improvement in decreased vision and CMT was remained stable increased (811 mmk). Vision was increased only after 2 week of i/v bevazicumab injection, macular edema resolved and CMT decreased (280 mmk) which was revealed by OCT. In conclusion, OCT quided i/v bevacizumab is safe and well tolerated treatment option for refractory PCME.

Ayurvedic management of pseudophakic cystoid macular edema: A case report

After cataract surgery, pseudophakic Cystoid macular edema is one of the main challenges to deal with for an ophthalmologist. It is a painless condition in which swelling or thickening occurs in the central retina (macula). Surgical trauma triggers the cascade of inflammatory reactions, leading to the breakdown of the blood-retinal barriers that lead to increased retinal capillary permeability which further causes edema. A 65-year-old female patient visited Shalakya tantra OPD with complaints of diminished vision in the right eye for two months. After a fundoscopic examination, she was diagnosed with right eye pseudophakic cystoid macular edema. The diagnosis was confirmed with OCT findings of the right eye. Intravitreal injections are costly and do not guarantee the reduction in pseudophakic CME. The patient was given Shamanaushadhis like punarnavasava vrihatavasakadi kwath, gokshuradi guggulu, chandraprabha vati and eranda taila as rechana dravya along with jalaukavacharan to reduce the edema caused by the fluid accumulation in the macular region. Significant improvement was seen in the patient’s visual acuity along with the reduction in macular edema.

Impact of prior pars plana vitrectomy on development of cystoid macular edema after uneventful cataract surgery.

To investigate whether a history of prior pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) predisposes to the development of pseudophakic cystoid macular edema (CME). New York Eye and Ear Infirmary of Mount Sinai, New York, New York. Retrospective cohort study. Records of 365 subjects who underwent PPV for RRD and subsequent cataract surgery between 2017 and 2020 were reviewed. Patients with a history of diabetic retinopathy, inflammatory retinal vascular disease, uveitis, advanced age-related macular degeneration, intraocular infection, myopic maculopathy, or significant intraoperative complications precluding posterior chamber intraocular lens placement were excluded. Age-matched subjects who underwent routine cataract surgery served as controls. Clinical data and macular optical coherence tomography (OCT) findings up to 4 years postoperatively were obtained. 54 eyes underwent uneventful cataract surgery by phacoemulsification and had a history of PPV with gas tamponade. 55 eyes underwent uneventful cataract surgery only. The average follow-up time after cataract surgery was 39.1 months. In eyes with a history of PPV, the incidence of OCT-detected CME was 27.8% (15/54) compared with 3.8% (2/55) in the control group ( P < .001) and the incidence of clinically significant CME was 18.5% (10/54) compared with 1.8% (1/55) in the control group ( P = .004). 80% (12/15) of CME cases were treated with topical therapy, and none required intravitreal injection. Prior PPV for RRD is associated with an increased incidence of pseudophakic CME after uneventful cataract surgery. Prophylactic or prolonged postoperative anti-inflammatory topical therapy may be prudent to consider in these patients.

Risk of Pseudophakic Cystoid Macular Edema in Fellow-Eye Cataract Surgeries: A Multicenter Database Study

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. Patients undergoing bilateral nonsimultaneous cataract surgeries in 8 UK National Health Service clinical centers between July 2003 and March2015. We excluded patients with a history of diabetic macular edema (DME) or CME and perioperative topical nonsteroidal anti-inflammatory drug use in either eye. We calculated the overall risk of pCME and used Poisson model with robust estimation of standard error to identify potential risk factors for pCME in the fellow eye. The risk of postoperative clinical pCME in the fellow eye. A total of 54 209 patients were included. The mean age was 74.6 ± 10.4 years, and 38.8% were male. The fellow eye developed pCME in 544 patients (1%). The risk of fellow-eye pCME among patients without first-eye pCME was 0.9%. However, the risk of fellow-eye pCME 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 (ERM) (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 the first-operated eye is the strongest independent risk factor for the development of pCME in the fellow eye. Our findings may guide clinicians in counseling patients on the risk of pCME before performing cataract surgery in the fellow eye and help in identifying high-risk patients who may benefit from prophylactic therapy. Proprietary or commercial disclosure may be found after the references.

Pseudophakic cystoid macular edema : Statement of the German Society of Ophthalmology, the German Retina Society and the German Professional Association of Ophthalmologists. Status 22 October 2022

Pseudophakic cystoid macular edema : Statement of the German Society of Ophthalmology, the German Retina Society and the German Professional Association of Ophthalmologists. Status 22 October 2022

Safety of the bag-in-the-lens implantation regarding the development of clinically significant pseudophakic cystoid macular edema: A retrospective case series study.

To determine the incidence of clinically significant pseudophakic cystoid macular edema (CSPME) after phacoemulsification using the 'bag-in-the-lens' lens (BIL) implantation technique and to examine the influence of associated risk factors for clinically significant pseudophakic macular edema (CSPME), both ocular and systemic. This retrospective study included 2419 first-operated eyes of 2419 adults who underwent phacoemulsification cataract surgery using the BIL implantation technique between January 2013 and December 2018 in the Antwerp University Hospital, Belgium. The significance of several risk factors (age, gender, previous history, intra- and postoperative complications) was examined by extraction of electronic medical files. The 3-month incidence of CSPME in the subgroup without risk factors was 0.00% (95% CI: 0.00 -NA). The 3-month incidence of CSPME in the subgroup with risk factors was 0.57% (95% CI 0.22-1.29%). The 3-month incidence of CSPME in the total population of 2419 patients was 0.29% (95% CI: 0.11-0.65%). The risk factors most significantly associated with CSPME included renal insufficiency (hazard ration [HR]: 5.42; 95% CI: 1.69-17.44; P = .014), exudative age-related macular degeneration (HR: 74.50, 95% CI: 25.75-215.6; P < .001) and retinal vein occlusion (HR: 22.48, 95% CI: 4.55-111.02; P = .005). In the absence of risk factors, the incidence of CSPME was zero. We can conclude that Primary Posterior Continuous Curvilinear Capsulorhexis (PPCCC) does not increase the risk for CSPME. Non-inferiority of the BIL implantation regarding the development of CSPME, relative to the traditional 'lens-in-the-bag' (LIB) implantation, confirms that BIL is a safe surgical technique. This study also illustrates a previously undescribed risk factor for developing CSPME, namely renal insufficiency.

The Classification of Common Macular Diseases Using Deep Learning on Optical Coherence Tomography Images with and without Prior Automated Segmentation.

We compared the performance of deep learning (DL) in the classification of optical coherence tomography (OCT) images of macular diseases between automated classification alone and in combination with automated segmentation. OCT images were collected from patients with neovascular age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic macular edema, retinal vein occlusion, cystoid macular edema in Irvine-Gass syndrome, and other macular diseases, along with the normal fellow eyes. A total of 14,327 OCT images were used to train DL models. Three experiments were conducted: classification alone (CA), use of automated segmentation of the OCT images by RelayNet, and the graph-cut technique before the classification (combination method 1 (CM1) and 2 (CM2), respectively). For validation of classification of the macular diseases, the sensitivity, specificity, and accuracy of CA were found at 62.55%, 95.16%, and 93.14%, respectively, whereas the sensitivity, specificity, and accuracy of CM1 were found at 72.90%, 96.20%, and 93.92%, respectively, and of CM2 at 71.36%, 96.42%, and 94.80%, respectively. The accuracy of CM2 was statistically higher than that of CA (p = 0.05878). All three methods achieved AUC at 97%. Applying DL for segmentation of OCT images prior to classification of the images by another DL model may improve the performance of the classification.

Glycemic control and macular edema in patients undergoing cataract surgery

AimsCataract, the most common cause of blindness, has higher prevalence among patients with diabetes mellitus. About 20% of cataract surgeries are performed on patients with diabetes. One of the complications of cataract surgery is pseudophakic cystoid macular edema (CME). This study examined whether patients’ glycemic control (as indicated by HbA1c level before cataract surgery) is associated with CME incidence within one year post-surgery. MethodsWe conducted a retrospective cohort study of 1285 diabetes patients over age 18 who underwent cataract surgery between January 2015 and January 2020. Data were obtained from medical records reporting glycated hemoglobin (HbA1c) level prior to surgery and post-operative CME with intraocular anti-vascular endothelial growth factor injections. ResultsThe patients with CME complications were younger, with longer duration diabetes, and higher percentages of type 1 diabetes and diabetic retinopathy. The main variables influencing risk of post-operative CME were found to be diabetic retinopathy and HbA1c level. Multivariate analysis revealed that HbA1c is an independent risk for post-operative CME with a relative risk of 2.01 when HBa1c is above 7 c (95% CI, 1.10–3.67). ConclusionThe study demonstrates that pre-cataract surgery diabetes control, measured by HbA1c level, is an independent risk factor for developing post-surgery CME.