Spectral-domain optical coherence tomography evaluation of postoperative cystoid macular oedema following phacoemulsification with intraoperative complication

Abstract

BackgroundTo report the rate of cystoid macular oedema (CMO) as detected by spectral-domain optical coherence tomography (SD-OCT) after intraoperative complication during phacoemulsification. The secondary objectives include comparing mean macular thickness and best-corrected visual acuity (BCVA) between those who developed postoperative CMO against those who did not.MethodsThis is a prospective cohort study conducted in a tertiary hospital between July 2009 and June 2010. Serial SD-OCT and BCVA were performed at baseline, 1 week, 6 weeks and 16 weeks postoperatively.ResultsSingle eyes from 47 subjects were analyzed; of these 16 (34%) eyes developed CMO. In the CMO group, mean macular thickness (±SD) increased sharply by 56 μm from 273 ± 24 μm at baseline to 329 ± 31 μm at 16 weeks; whereas in the non-CMO group, macular thickness showed a slight increase of 14 μm from 259 ± 21 μm to 272 ± 20 μm. In the CMO group, mean BCVA (in logarithm of minimum angle of resolution) improved modestly from 0.92 ± 0.66 to 0.66 ± 0.41 at week 16; while in the non-CMO group, mean BCVA improved markedly from 0.98 ± 0.59 to 0.21 ± 0.13. The two groups differed significantly in mean macular thickness (p < 0.001) and mean BCVA (p < 0.001) at 16 weeks.ConclusionAs detection rate of CMO is high, postoperative OCT monitoring for patients with intraoperative complications allows earlier diagnosis and treatment.

The Prophylactic Effect of Topical Ketorolac Tromethamine on Macular Thickening after Phacoemulsification in Diabetic Patients

“…However, some factors are diagnosed to increase the risk of macular thickening such as the presence of insulin-dependent diabetes mellitus, duration of diabetes ≥10 years, the severity of diabetic retinopathy, and prior treated diabetic ME. The results of the present study are in contrast to the ndings of Elsawy et al 20 , and Singal et al 8 . Our patients (both ketorolac and placebo groups) had good diabetes control (FBS≤126 mg/dl and HbA1c <7%), most of them had no diabetic retinopathy or mild nonproliferative diabetic retinopathy and used oral agents or just were on diet to control their diabetes.…”

“…13 Ketorolac tromethamine is a potent non-steroidal anti-in ammatory drug (NSAID) that inhibits cyclooxygenase enzymes and thus decreases the level of ocular prostaglandins and consequently the chance of cystoid ME when applied topically. [15][16][17][18] In the study by Nikkhah et al, the effective and sustainable in uence of the topical ketorolac was reported in diabetic patients to treat diabetic ME, the same nding was also reported by Elsawy et al, 20 in spite of the above-mentioned studies, inconclusive therapeutic effects of topical NSAIDs to prevent post-phacoemulsi cation ME was determined by a meta-analysis conducted in tromethamine 0.5% on post-phacoemulsi cation macular thickening compared to placebo in diabetic patients.…”

“…Furthermore, the prophylactic effect of topical ketorolac against the development of post-cataract surgery ME in diabetic patients was evaluated by Elsawy et al 20 The patients were divided into ketorolac group, who received topical ketorolac tromethamine 0.4% twice a day for 12 weeks in addition to dexamethasone 0.1% four times a day and control group, who received only topical dexamethasone 0.1%. Contrary to the present study, the above-mentioned trial found a signi cantly increased rate of postoperative ME in diabetic patients in the control group compared to the ketorolac group.…”

Management of Irvine-Gass syndrome with a scleral intraocular lens

“…This complication would occur in 8% of cases and can be chronic despite optimal treatment in 3% of cases. 1,2 This pseudophakic macular edema generally appears between the first and the sixth month postoperatively. The pathophysiology of pseudophakic cystoid macular edema is multifactorial.…”

Effect of Phacoemulsification on Sub Foveal Choroidal and Central Macular Thickness as measured by Swept Source Optical Coherence Tomography

“…Few studies have evaluated role of phacoemulsification on Central Macular Thickness (CMT). 6 Any change or oedema after cataract surgery has profound effect on vision of patient undergoing cataract surgery. Different studies have also evaluated the role of uneventful phacoemulsification cataract surgery on Subfoveal Choroidal Thickness (SFCT).…”