Risk Of Cystoid Macular Edema Research Articles

Aqueous humor perturbations in chronic smokers: a proteomic study

The detrimental effects of smoking are multisystemic and its effects on the eye health are significant. Smoking is a strong risk factor for age-related nuclear cataract, age-related macular degeneration, glaucoma, delayed corneal epithelial healing and increased risk of cystoid macular edema in patients with intermediate uveitis among others. We aimed to characterize the aqueous humor (AH) proteome in chronic smokers to gain insight into its perturbations and to identify potential biomarkers for smoking-associated ocular pathologies. Compared to the control group, chronic smokers displayed 67 (37 upregulated, 30 downregulated) differentially expressed proteins (DEPs). Analysis of DEPs from the biological point of view revealed that they were proteins involved in complement activation, lymphocyte mediated immunity, innate immune response, cellular oxidant detoxification, bicarbonate transport and platelet degranulation. From the molecular function point of view, DEPs were involved in oxygen binding, oxygen carrier activity, hemoglobin binding, peptidase/endopeptidase/cysteine-type endopeptidase inhibitory activity. Several of the upregulated proteins were acute phase reactant proteins such as clusterin, alpha-2-HS-glycoprotein, fibrinogen, alpha-1-antitrypsin, C4b-binding protein and serum amyloid A-2. Further research should confirm if these proteins might serve as biomarkers or therapeutic target for smoking-associated ocular diseases.

К вопросу оптимального выбора нестероидных противовоспа- лительных средств в схеме ведения пациента с катарактой

This article aims to review the up-to-date approaches to the control of a non-specific inflammatory response following cataract phacoemulsification with intraocular lens implantation. The authors highlight the key objectives of using nonsteroidal anti-inflammatory agents after cataract surgery during the entire postoperative period, primarily to control inflammatory response and pain and to reduce the risk of cystoid macular edema. The article presents a wide range of data on the outcomes of using various nonsteroidal anti-inflammatory drugs (NSAIDs) in postoperative patients. Over the past years, classical approaches to the selection of patient management schemes have been revised taking into consideration findings of the numerous multicenter trials constructed on the principles of evidence-based medicine. The authors provide rationale for the selection of an optimal anti-inflammatory drug underpinned by the clinical trial results, pharmacodynamic and pharmacokinetic parameters of NSAIDs of a new generation. The emphasis is made on the use of bromfenac in patients with cataract. In addition, the risk factors and the major strategies of prevention and treatment of macular edema following surgical procedures are reviewed, including those in patients with diabetes mellitus. Keywords: cataract surgery, cystoid macular edema, NSAID, bromfenac, diabetes mellitus, perioperative period. For citation: Morozova T.A. On the optimal selection of nonsteroidal anti-inflammatory drugs in the management scheme of cataract patients. Russian Journal of Clinical Ophthalmology. 2023;23(1):54–59 (in Russ.). DOI: 10.32364/2311-7729-2023-23-1-54-59.

Evaluation of Subretinal fluid Drainage Techniques During Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment—ELLIPSOID Study

To compare visual acuity and photoreceptor integrity following pars plana vitrectomy with drainage from the peripheral retinal break(s) (PRB), posterior retinotomy (PR), or perfluorocarbon liquid (PFCL) for macula-off rhegmatogenous retinal detachment. Retrospective consecutive interventional comparative clinical study. 300 consecutive patients (300 eyes) with primary macula-off rhegmatogenous retinal detachment underwent 23-gauge pars plana vitrectomy with subretinal fluid drainage through PRB (n=100), PR (n=100), or with PFCL (n=100). Visual acuity and spectral-domain optical coherence tomography were performed preoperatively and at 3, 6, and 12 months postoperatively. Primary outcomes were visual acuity and discontinuity of the external limiting membrane, ellipsoid zone, interdigitation zone, and retinal pigment epithelium at 1 year. Baseline characteristics were similar. Single-operation reattachment rates were as follows: PRB 86%, PR 85%, and PFCL 83% (P=.9). Mean (±SD) logMAR visual acuity at 1 year was greater with PRB and PR compared with PFCL (PRB 0.6 ± 0.5, PR 0.7 ± 0.6, PFCL 0.9 ± 0.6, P=.002). There was an association between drainage technique and discontinuity of the external limiting membrane (PRB 26%, PR 24%, PFCL 44%, P=.001), ellipsoid zone (PRB 29%, PR 31%, PFCL 49%, P < .001), and interdigitation zone (PRB 43%, PR 39%, PFCL 56%, P=.004). There was an association between drainage technique and risk of cystoid macular edema (PRB 28%, PR 39%, PFCL 46%, P=.003) and epiretinal membrane (PRB 64%, PR 90%, PFCL 61%, P < .001). PFCL-assisted drainage is associated with worse visual acuity and greater risk of outer retinal band discontinuity and cystoid macular edema compared with PRB or PR. PR had a greater risk of epiretinal membrane compared with PRB and PFCL. PRB had the best outcomes overall. Drainage technique may impact long-term anatomic and functional outcomes.

Risk of Cystoid Macular Edema after Cataract Surgery in Retinitis Pigmentosa: An Analysis of United States Claims from 2010 to 2018

Cataract surgery is commonly performed to improve vision in patients with retinitis pigmentosa (RP). However, the risk of postoperative cystoid macular edema (CME) in RP remains unclear. Here, we leveraged a large multiyear claims database to estimate the risk of CME after cataract surgery in patients with and without RP. Retrospective multicenter cohort. Patients aged 18 to 65 years who underwent single-phase cataract surgery between January 1, 2020, and December 31, 2018. Identified using the IBM MarketScan claims database. We evaluated the baseline characteristics and outcomes and estimated the hazard ratio (HR) using a multivariable mixed-effects approach. The eyes of patients with RP were categorized as group R1, and those without diagnoses of RP by the time of surgery were categorized as group R0. Incident postoperative CME in the same eye that underwent cataract extraction within 12 months of the procedure. We included 468 123 patients and 615 645 eyes. This included 124 eyes with RP (R1) and 615 521 without RP (R0). The mean ages were 50.5 ± 9.8 years in R1 and 57.9 ± 6.1 years in R0. The cumulative incidence of CME at 12 months was 5.8% (95% confidence interval [CI] 1.2%-10.3%) in R1, and it was 1.1% (95% CI 1.1%-1.2%) in R0. On average, CME was reported in R1 subjects 3.9 weeks later than in R0 subjects (95% CI 2.04-6.5 weeks; P <0.001). The subjects in R1 had 4.83 (95% CI 2.13-10.93, P <0.001) times the risk of CME compared to the subjects in R0. A stratified analysis showed that epiretinal membrane (ERM) decreased the risk of CME in R1 (HR 0.12 [95% CI 0.48-0.97; P= 0.004]) but increased it in R0 (HR, 4.32 [95% CI 3.13-5.95; P<0.001]). The cataract surgery-related risk of CME among patients with RP may be >4 times that among people without RP. Men and individuals aged 18 to 34 and 55 to 65 years may be at the greatest risk, whereas ERM may lower the risk. Further study is warranted to stratify the risk by RP genotype and phenotype and illuminate the natural history, angiographic features, and functional consequences of postoperative CME.

Laser flare and cell photometry to measure inflammation after cataract surgery: a tool to predict the risk of cystoid macular edema.

To review the current adoption of laser flare and cell photometry (LFCP) in the setting of modern cataract surgery to analyze inflammation aiming to identify evidence of a correlation between LFCP values and the risk of cystoid macular edema (CME) development. An extensive PubMed literature search was performed to review all the published studies investigating inflammation by LFCP after uncomplicated phacoemulsification. The following keywords were used: cataract surgery, cystoid macular edema, anterior chamber inflammation, laser flare, and cell photometry. Seventy-eight original articles investigating inflammation by LFCP were selected. Macula alterations were searched in 12 (15%) trials, by optical coherence tomography or fluorescein angiography in 11 (14%) and 1 (1%) studies, respectively. Among them, 9 (12%) papers investigated the correlation between LFCP values and cystic changes to the macula: 7 (9%) and 2 (3%) studies identified a positive and negative correlation, respectively. Three (4%) papers did not perform any correlation analysis. CME, as a consequence of uncontrolled postoperative inflammation, is a common cause for unfavorable visual outcomes following uncomplicated phacoemulsification with IOL implantation. After surgery, intraocular inflammation is generally assessed by qualitative methods. Although well-established and practical in uveitis, they are inadequate to detect the modest inflammatory response that usually occurs after uneventful phacoemulsification. LFCP correlate with the chance of macula alteration after surgery and higher the values higher the risk of CME. The quantitative analysis of intraocular inflammation by LFCP after cataract surgery might be a tool to predict the risk of pseudophakic CME.

Comparison of Three Intraocular Lens Implantation Procedures for Aphakic Eyes With Insufficient Capsular Support: A Network Meta-analysis

To compare the clinical outcomes and main complications of transscleral-fixated (TSF), intrascleral-fixated (ISF), and iris-fixated (IF) intraocular lenses (IOLs). Systematic review and network meta-analysis. The authors searched PubMed, EMBASE, and the Cochrane Library for relevant articles up to April 2017 with no language restrictions, and related studies meeting the eligibility criteria were included. A Bayesian framework was applied to compare the visual outcomes and complications of these 3 approaches. A total of 14 studies with 845 eyes were included in the present report. There was no significant difference between any pair of surgical approaches in best-corrected visual acuity (BCVA) and in final BCVA achieving 20/40 or better (Snellen). ISF presented a lower risk of cystoid macular edema (CME) compared with TSF (risk ratio [RR], 0.45; 95% confidence interval [CI], [0.18, 1.0]). IF showed superiorities in less intraocular hemorrhage (IOH) than ISF (RR, 0.078; 95% CI [0.0095, 0.38]), as well as TSF (RR, 0.26; 95% CI, [0.09, 0.72]). IF had a lower risk of glaucoma escalation; the difference was slightly higher than the conventional level of significance (RR, 0.41; 95% CI, [0.16, 1.04]). Moreover, the surgical time in IF was shorter than TSF (standard mean difference [SMD], -2.98; 95% CI, [-4.32, -1.64]) and ISF (SMD, -2.60; 95% CI, [-3.71, -1.49]). However, IF was associated with a significantly higher risk of endothelial cell density (ECD) impairment (SMD, -0.54; 95% CI, [-1.02, -0.05]) and significantly greater postoperative corneal endothelial cell loss rate (ECLR, %) (SMD, 0.35; 95% CI, [0.08, 0.63]) compared with TSF. Postoperative visual outcomes were comparable among TSF, ISF, and IF for eyes with insufficient capsular support. However, the risk of some complications differed among approaches. IF showed its superiorities in lower risk of IOH and glaucoma escalation as well as shorter surgical time, while IF was at a disadvantage in greater endothelial cell impairment. Since some patients might have a clear contraindication to one of the surgical approaches, the decision of surgical approach eventually depends on surgeon experience and the presenting pathology.

Cataract Surgery Outcomes in Eyes With Primary Epiretinal Membrane

Primary epiretinal membrane (ERM) is a common retinal disorder with a prevalence of 4% to 18.5%. Although ERM and cataracts commonly occur together, to our knowledge, no studies have investigated the outcome of cataract surgery alone in this setting. To analyze the visual outcome and cystoid macular edema risk with cataract surgery in eyes with primary ERM. In this retrospective clinical database study, data were collected from July 2003 to March 2015 from 8 locations in the United Kingdom. Cataract surgery data of 217 557 eyes were extracted from the electronic medical record of the UK National Health Service. After exclusion of 57 561 eyes with combined surgery, prior vitrectomy, copathology, and complications, 812 eyes with primary ERM and 159 184 reference eyes were analyzed. We report on visual acuity (VA), the incidence of cystoid macular edema, and the need for ERM surgery. The mean (SD) age of patients in the ERM group was 73.7 (9.23) years, and 395 of 812 were men (46.8%). The mean (SD) age of patients in the reference group was 74.4 (12.19) years, and 65 265 of 159 184 were men (41%). Epiretinal membrane eyes assessed at 4 to 12 weeks postoperatively gained 0.27 (0.32) logMAR (approximately 3 Snellen lines), with 200 of 448 (44.6%) improving by 0.30 logMAR or more (≥3 Snellen lines) and 32 of 448 (7.1%) worsening by 0.30 logMAR or more. Reference eyes gained a mean (SD) of 0.44 (0.26) logMAR (approximately 4 Snellen lines), with 48 583 of 77 408 (62.8%) improving by 0.30 logMAR or more and 2125 of 77 408 (2.7%) worsening by 0.30 logMAR or more. Although all eyes with preoperative VA of 20/40 or less improved, only reference eyes with preoperative VA of more than 20/40 showed improvement. Cystoid macular edema developed in 57 of 663 ERM eyes (8.6%) (95% CI, 6.69-10.98) and 1731 of 125 435 reference eyes (1.38%) (95% CI, 1.32-1.45) (P < .001). Epiretinal membrane surgery was performed in 43 of 663 (6.5%) ERM eyes. On average, VA improved 0.27 logMAR (approximately 3 Snellen lines) in eyes with ERM. Eyes with ERM and VA of 20/40 or less showed more benefit after cataract surgery than those with better preoperative vision. However, compared with eyes without ERM, higher rates of cystoid macular edema and a lower postoperative VA gain were noted.

Decision-making and management of uveitic cataract.

The visual outcome of uveitic cataract surgery depends on the underlying uveitic diagnosis, the presence of vision-limiting pathology and perioperative optimization of disease control. A comprehensive preoperative ophthalmic assessment for the presence of concomitant ocular pathology, with particular emphasis on macula and optic nerve involvement, is essential to determine which patients will benefit from improved vision after cataract surgery. Meticulous examination in conjunction with adjunct investigations can help in preoperative surgical planning and in determining the need for combined or staged procedures. The eye should be quiescent for a minimum of 3 months before cataract surgery. Perioperative corticosteroid prophylaxis is important to reduce the risk of cystoid macular edema and recurrence of the uveitis. Antimicrobial prophylaxis may also reduce the risk of reactivation in eyes with infectious uveitis. Uveitic cataracts may be surgically demanding due to the presence of synechiae, membranes, and pupil abnormalities that limit access to the cataract. This can be overcome by manual stretching, multiple sphincterotomies or mechanical dilation with pupil dilation devices. In patients <2 years of age and in eyes where the inflammation is poorly controlled, intraocular lens implantation should be deferred. Intensive local and/or oral steroid prophylaxis should be given postoperatively if indicated. Patients must be monitored closely for disease recurrence, excessive inflammation, raised intraocular pressure, hypotony, and other complications. Complications must be treated aggressively to improve visual rehabilitation. With proper patient selection, improved surgical techniques and optimization of peri- and post-operative care, patients with uveitic cataracts can achieve good visual outcomes.

Immediate Postoperative Intraocular Pressure Adjustment Reduces Risk of Cystoid Macular Edema after Uncomplicated Micro Incision Coaxial Phacoemulsification Cataract Surgery.

PurposeTo determine the accuracy of visual estimation of immediate postoperative intraocular pressure (IOP) following microincision cataract surgery (MICS) and the effect of immediate postoperative IOP adjustment on prevention of cystoid macular edema (CME).SettingAmbulatory surgical center.MethodsProspective, randomized analysis of 170 eyes in 135 patients with MICS, performed in a Medicare approved outpatient ambulatory surgery center. Surgical parameters included a keratome incision of 1.5 mm to 2.8 mm, topical anesthetic, case completion IOP estimation by palpation and patient visualization of light, and IOP adjustment before exiting the operating theater. IOPs were classified into three groups: low (<16 mmHg), normal (16 to 21 mmHg), and elevated (>21 to 30 mmHg). IOP measurements were repeated 1 day after surgery. Optical coherence tomography (Stratus OCT, Zeiss) was measured at 2 weeks. An increase in foveal thickness greater than 15 µm was used to indicate CME. Statistical analysis was performed using one- and two-tailed Student's t-tests.ResultsMean minimal foveal thickness averaged 207.15 µm in the low pressure group, 205.14 µm in the normal IOP group, and 210.48 µm in the elevated IOP group 2 weeks following surgery. CME occurred in 14 of 170 eyes (8.2%) at 2 weeks (low IOP, 35.7%; normal IOP, 14.2%; elevated IOP, 50.0%). Change in IOP from the operating theater to 1 day after surgery was within +/−5 mmHg in 54 eyes (31.7%), elevated by 6 to 15 mmHg in 22 eyes (12.9%), and elevated more than 15 mmHg in four eyes (2.3%). IOP was reduced by 6 mmHg to 15 mmHg in 39 eyes (22.9%) and reduced by more than 15 mmHg in nine eyes (5.3%).ConclusionsImmediate postoperative adjustment of IOP may prevent CME in MICS. Physicians can improve their ability to estimate postoperative IOP with experience in tonometry to verify immediate postoperative IOP. There are patient safety and economic benefits to immediate IOP adjustment in the operating theater.SynopsisImmediate postoperative IOP adjustment following cataract surgery before the patient leaves the operating theater may reduce the incidence of CME and provide patient safety and economic benefits.

Effectiveness and Safety of an Intracameral Injection of Cefuroxime for the Prevention of Endophthalmitis After Cataract Surgery With or Without Perioperative Capsular Rupture.

Postoperative endophthalmitis (POE) often results in severe visual impairment. In clinical studies, an intracameral cefuroxime injection at the end of surgery was found to be effective at reducing the incidence of POE. Two important issues are the retinal safety of cefuroxime and its use for patients with perioperative capsular rupture where the risk of POE is dramatically increased. To assess the effectiveness and retinal safety of an intracameral injection of cefuroxime sodium for the prevention of POE and its possible use in cases of a perioperative capsular rupture of the lens. Population-based cohort study of patients 40 years of age or older who underwent cataract surgery at 1 of 1546 French health care facilities, public or private, and whose medical records were obtained from the national administrative database. Data analyses were performed between March and November 2015. The effectiveness and safety of the prophylactic injection of cefuroxime as measured by the incidence of POE and cystoid macular edema. From January 2010 to October 2014, a total of 3 351 401 eyes of 2 434 008 patients 40 years of age or older (58.9% were women, and the mean [SD] age was 73.9 [9.5] years) underwent cataract surgery; 1941 patients (0.08%) developed POE during the 6 weeks after cataract surgery. The incidence of POE after cataract surgery decreased over the course of the study (0.11%, 0.09%, 0.08%, 0.06%, and 0.05% in 2010, 2011, 2012, 2013, and 2014, respectively [P = .001 for trend]) as the use of cefuroxime prophylactic injections increased (11.1%, 14.4%, 32.8%, 64.8%, and 79.1% in 2010, 2011, 2012, 2013, and 2014, respectively [P = .001 for trend]). After multivariate adjustment, the risk of POE was reduced with the use of cefuroxime (odds ratio, 0.61 [95% CI, 0.56-0.68]). The retinal safety of an injection of cefuroxime, which was assessed by multiadjusted odds of retinal cystoid macular edema, was not increased for patients receiving cefuroxime injections (odds ratio, 0.86 [95% CI, 0.71-1.05]). For patients with a perioperative capsular rupture of the lens (the major risk factor for POE), the incidence of POE was lower for those who received an injection of cefuroxime than for those who did not (0.37% vs 0.51%, respectively [P = .001]), whereas an increased risk of cystoid macular edema was not identified for those who received or did not receive an injection of cefuroxime (5.6% vs 7.3%, respectively [P = .12]). These data suggest that, in routine practice, the intracameral injection of cefuroxime at the conclusion of cataract surgery is associated with a lower risk of POE and is safe for patients with or without a perioperative capsular rupture. While these data might be used to support the consideration of its routine use to prevent POE, in the absence of a randomized clinical trial, they cannot prove a direct cause-and-effect relationship between the injection of cefuroxime and POE.

Prospective, Randomized Study Comparing the Effect of 0.1% Nepafenac and 0.4% Ketorolac Tromethamine on Macular Thickness in Cataract Surgery Patients With Low Risk for Cystoid Macular Edema.

This study aimed to compare the short-term efficacy of 0.1% nepafenac with that of 0.4% ketorolac tromethamine in patients with low risk factors for cystoid macular edema (CME) undergoing phacoemulsification. A prospective, randomized, parallel-assignment efficacy trial. Two hundred eyes of 200 patients were randomized into 2 groups, one receiving nepafenac and the other receiving ketorolac perioperatively. Primary outcome measures were change in central macular thickness (CMT) at the 30th postoperative day and the incidence of possible subclinical CME (increase in CMT of >10 and >40 μm from baseline) on ocular coherence tomography (OCT). Secondary outcomes measured were the incidence of definite subclinical CME on OCT (>40 μm increase in CMT from baseline) and clinically significant CME at 1-month follow-up. A subgroup analysis of diabetic and hypertensive patients included in the study was made postoperatively. Difference in CMT at 1 month (P = 0.43) and presence of possible subclinical CME (P = 0.18) were comparable in both groups. The incidence of possible subclinical CME was 22.7%. None of the patients developed clinical CME or definite subclinical CME. In the diabetic subgroup, nepafenac showed significantly less CMT difference than ketorolac did at 1 week after the operation (P = 0.04) but not at 1 month (P = 0.09). Postoperative macular thickening after cataract surgery in eyes with low CME risk is similar with nepafenac and ketorolac. A larger population of diabetic patients should be studied to verify any beneficial effect of nepafenac on this subgroup.

Postoperative care in cataract surgery

The purpose of this study is to provide a summary of current trends and recent developments in postoperative care after cataract surgery. There is new evidence challenging the routine use of a protective eye shield after uncomplicated cataract surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in decreasing the risk of cystoid macular edema (CME) in high-risk eyes, but must be used with caution in patients with prior corneal disease. Pre-existing ocular comorbidities can have significant effects on postoperative outcomes. Management of postoperative visual expectations can be challenging in patients receiving newer advanced technology intraocular lenses (IOLs). Key practices such as restrictions on activities, prophylactic regimens against infection and inflammation, appropriate follow-up with adjustments for individual risk factors and management of complications, and continuing care until visual rehabilitation is complete are advised to optimize visual outcome for patients after cataract surgery.

Double Intraocular Lens: Dislocated One into Vitreous and Implanted One into Posterior Chamber

Phaco-emusification is the most preferred technic at cataract surgery. Rate of dislocated intraocular lens (IOL) into the vitreous has been increased in this surgery. We reported here the results of a case who has dislocated IOL into the vitreous at the time of phaco-emulsification surgery and posterior chamber IOL located to sulcus at a secondary surgical procedure. If the patients have dislocated IOL into the vitreous and they have not any complication and visual acuity loss; IOL can be remain at the place of dropped. However, increasing risk of cystoid macular edema and retinal detachment should be remember, and these cases should be follow closely.

Tobacco smoking influences on eye diseases and vision

I read the article of Lois et al 1 with great interest. I believe, however, that at least in some points it should be supplemented. My recent survey2 concerning a...

The Development of Complications in Patients With Chronic Anterior Uveitis

This study aimed to identify the factors determining the ocular complications and visual outcome in patients with chronic anterior uveitis. Retrospective, noncomparative case study. Ninety-one eyes of 68 patients with anterior uveitis that lasted longer than 3 months were assessed. Patients were divided into idiopathic and nonidiopathic chronic anterior uveitis and Fuchs' heterochromic uveitis. Visual acuity and complications such as posterior synechiae, cataract formation, raised intraocular pressure (IOP), and posterior segment complications (i.e., cystoid macular edema and optic nerve involvement) were evaluated. Poor visual outcome measured by life-table analysis was considered when logMAR (log of the reciprocal of Snellen visual acuity) visual acuity was 0.3 or worse. No statistically significant differences in the visual outcome were found between the three groups of patients with chronic anterior uveitis. Posterior synechiae formation was, as expected, significantly increased in patients with chronic anterior uveitis compared with those with Fuchs' heterochromic uveitis. There was a trend for patients with nonidiopathic chronic anterior uveitis to have an increased risk of cystoid macular edema compared with those with idiopathic disease. There were no significant differences in visual outcome between any of the groups with time. The visual prognosis for patients with chronic anterior uveitis is generally good. Posterior segment complications appear to be more likely to occur if there is an underlying associated disease. However, the presence of complications does not seem to affect the visual outcome in patients with chronic anterior uveitis.

Ocular complications of pediatric uveitis

To determine the cumulative proportion and the visual significance of ocular complications of pediatric uveitis. Cohort study. Patients with onset of endogenous or infectious uveitis before or at age 16 years. Retrospective review of existing records at a university-based uveitis clinic. Type and prevalence of complications related to uveitis, time to development of complications, and vision loss after initial diagnosis. There were 148 patients, 71 males and 77 females, with a mean age of 10.4+/-4.9 years (median, 10.3 years) for an estimated prevalence of pediatric uveitis of 13.8%. Noninfectious uveitis was present in 112 patients (75.7%); 105 (71%) patients had bilateral disease. Anterior uveitis accounted for 30.4%, intermediate uveitis for 27.7%, posterior uveitis for 23.7%, and panuveitis for 18.2% of patients. Patients were followed for a mean of 71.7 months (range, 0 months-44 years) after diagnosis. Approximately 34% of all patients had 1 or more complications at the time of first diagnosis of uveitis by an ophthalmologist, increasing to 61.6% by 3 months, 69.4% by 6 months, 75.2% by 1 year, and 86.3% by 3 years after diagnosis. There were a total of 617 complications of all types. Anterior and intermediate uveitis had a higher risk of band keratopathy (P = 0.005). Posterior and intermediate uveitis had a lower risk of cataract (P = 0.009) or posterior synechiae (P<0.001). Intermediate uveitis had a higher risk of cystoid macular edema compared with anterior or posterior uveitis (P = 0.002). The cumulative percentages (standard error) of patients with first loss to 20/200 or worse after diagnosis in the affected eyes of unilateral cases or in either eye of the bilateral cases were: 31.3% (3.9) at 1 month; 40.5% (4.1) at 6 months; 56.0% (4.3) at 24 months; and 69.6% (4.5) at 60 months. Fifty-four patients (48.2%) received systemic antiinflammatory or immunomodulatory therapy. Sixty-eight patients (45.9%) had ocular surgery, and 38 of these had ocular surgery in both eyes. Childhood uveitis is significant for numerous complications, many of which are vision threatening. Complications increase with duration of disease.

Cystoid macular edema in aphakia and pseudophakia after use of prostaglandin analogs

Prostaglandin analogs are powerful ocular hypotensive agents that may also be associated with a breakdown of the blood-retinal barrier and cystoid macular edema. The association is evident in pseudophakic or aphakic patients. This paper presents a case of unilateral latanoprost-associated clinical cystoid macular edema in a bilaterally pseudophakic patient; the only difference between the two eyes was the presence of a capsulotomy in the affected eye. We review the literature concerning prostaglandin analog-associated cystoid macular edema, as well as the evidence for prostaglandin analog-associated breakdown of the bloodretinal barrier. Although some evidence is suggestive of a connection between prostaglandin analogs and cystoid macular edema, many questions concerning the complex physiology of prostanoids remain. Until our understanding of these issues is more advanced, judicious use of prostaglandin analogs in patients at risk for cystoid macular edema would be prudent.

Cystoid macular edema associated with latanoprost in aphakic and pseudophakic eyes

PURPOSE: To describe four patients who developed cystoid macular edema shortly after onset of treatment with latanoprost. METHOD: Retrospective review of medical records of patients with open-angle glaucoma who developed cystoid macular edema shortly after starting latanoprost. RESULTS: The use of topical latanoprost was temporally related to the development of cystoid macular edema in four patients (six eyes; two aphakic eyes and four pseudophakic eyes). Cystoid macular edema resolved in all patients after latanoprost was discontinued. CONCLUSIONS: Cystoid macular edema is a potential complication of latanoprost therapy. Further observations are needed to determine if the risk of cystoid macular edema is limited to or greatest in patients who are pseudophakic or aphakic.

Macula study with standardized echography.

At an early clinical stage, patients with cystoid macular oedema show no significant changes in their vision. This phase is described as angiographic cystoid macular oedema. Echographic macular studies have in the past years shown that the macular thickness is increased in the early stages of cystoid macular oedema. In these patients there was no evidence of cystoid macular oedema with the visual acuity test, B-scan echography and fluorescein angiography. In this paper an echographic macular study by standardized A-scan echography was performed in 537 patients before extracapsular cataract extraction and intraocular lens implantation in posterior chamber (ciliary sulcus). The results showed that this method is very sensitive in detecting patients with high risk of cystoid macular oedema.