The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery—a Scottish Ophthalmological Surveillance Unit study

Abstract

Purpose Post-operative cystoid macular oedema (CMO) can cause deterioration of vision following routine cataract surgery. The incidence of persistent CMO (pCMO; defined as CMO present after 3 months) following uncomplicated surgery is uncertain. We wished to identify the incidence, management and visual outcomes of such patients. Methods A Scottish Ophthalmological Surveillance Unit (SOSU) questionnaire was sent monthly to every ophthalmic specialist in Scotland over an 18-month period from 1st January 2018 asking them to report all new patients with pCMO confirmed on OCT scanning following uncomplicated cataract surgery. A follow-up questionnaire was sent 9 months after initial presentation. Results Fourteen cases of pCMO were reported, giving an incidence of 2.2 cases of pCMO per 10,000 uncomplicated cataract surgeries. Mean age was 74.9 years (SD 10.2; range 44-86) with a male preponderance (72.7%). Two patients developed pCMO in each eye. Six cases (46.2%) had hypertension and one had diabetes. Three eyes required intracameral adjuncts (two iris hooks, one intracameral phenylephrine). Postoperative visual acuity (VA) at 3 months was logMAR 0.48 (0.2-0.8). Average mean central retinal thickness (CRT) at 3 months was 497microns (270-788). The most common initial treatment comprised topical steroids and topical NSAIDs (61.5%). Other management strategies included systemic steroids, intravitreal steroids and oral acetazolamide. At 1-year post-op, mean VA was logMAR 0.18 (0.1-0.3) with average mean CRT of 327microns (245-488). Conclusions We identified a low incidence of pCMO following uncomplicated cataract surgery in Scotland (0.02%), with inconsistent and variable management regimes. A nationally agreed treatment protocol is required.

Impact of cessation of regular cataract surgery during the COVID pandemic on the rates of posterior capsular rupture and post-operative cystoid macular oedema

“…In the cases with CMO, there was no difference in the proportion of diabetics across both P2 and P3 or pre-operative BCDVA or of combined cases of PCR with subsequent CMO (Table 2), suggesting that these were not important factors in increased rates. The incidence of reported post-operative CMO after CS ranges from 0.02-7.6% [17][18][19], dependent on the population examined, risk factors and intraoperative complications. A self-reported survey in a predominantly Caucasian population in Scotland found an incidence of 0.02% [17] while in an ethnically diverse London population with high number of diabetic patients the rate of CMO was 7.6% [18].…”

“…The incidence of reported post-operative CMO after CS ranges from 0.02-7.6% [17][18][19], dependent on the population examined, risk factors and intraoperative complications. A self-reported survey in a predominantly Caucasian population in Scotland found an incidence of 0.02% [17] while in an ethnically diverse London population with high number of diabetic patients the rate of CMO was 7.6% [18]. In our patients there was an increased incidence of CMO (p < 0.0001) during COVID with 49 episodes (4.9%) in P2 and 58 (6.85%) during P3.…”

“…Commercial pilots are also required to undertake time on flight simulators, as well as supervised flights, after any extended breaks [27,28]. Considering the results of this current and similar recent studies [17] and with the knowledge that extensive breaks from surgery lead to skill fade [9][10][11][12], it would seem very sensible that Ophthalmology attempts to learn lessons from the aviation industry by investigating factors that may optimise returns after surgical breaks. Clearly, there is a need, to improving patient safety, of more support for surgeons of all grades when they return to surgery after an extended hiatus, with the development of robust guidelines and including perhaps mandatory time spend on surgical simulators.…”

Survey of UKISCRS consultant members regarding preferred practice management of persistent Cystoid Macular Oedema

“…A recent Scottish Ophthalmic Surveillance Unit survey reported a low incidence of persistent Cystoid Macular Oedema (pCMO) at 3 months following uncomplicated cataract surgery in Scotland (2.2 cases per 10,000; 0.02%; based on an average of 42,000 cataract operations/year), with inconsistent and variable management regimes [1]. As there are over 400,000 cataract procedures performed annually across the UK, that could translate to more than 80 pCMO cases nationally.…”

Incidence of Pseudophakic Cystoid Macular Oedema Post-Cataract Surgery in Illawarra Shoalhaven Local Health District, Australia

“…Although the associations between cataract surgery and PCMO have been discussed in many articles, the incidence and time course vary [17, 18]. In this study, a retrospective analysis was performed on patients undergoing routine cataract surgery to report the incidence and risk factors for PCMO in the Illawarra Shoalhaven local health district (ISLHD) of Australia and associated changes in visual acuity.…”