Vitreous hyper-reflective dots in pseudophakic cystoid macular edema assessed with optical coherence tomography

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.

Vitreous hyper-reflective dots and the macular thickness after cataract surgery

“…Also other factors like pseudoexfoliation and zonular weakness might have contributed to lens fragment dispersion into the vitreous and consequently to the inflammatory response resulting in macular thickening. However, in our previous study, we could not find an association between pseudoexfoliation and CST [12]. Therefore we did not further focus on this issue.…”

“…Probably, these lens fragments migrate towards the retina postoperatively and become visible with OCT as VHDs. Since decapsulated lens fragments provoke inflammation, VHDs presumably promote an inflammatory response and thus macular thickening [11][12][13][14][15]. The appearance of retro-capsular lens fragments after phacoemulsification was already reported in 17% eyes [15].…”

“…Its occurrence is based on the postoperative release of inflammatory mediators causing blood-retina barrier breakdown and the up-regulation of pro-inflammatory genes and proteins in the retina [8][9][10]. Recently, vitreous hyper-reflective dots (VHDs) were identified as a highly significant risk factor for pseudophakic CME [11,12]. VHDs presumably represent lens fragments that are formed during phacoemulsification and accelerated through the zonula retro-capsular into the space of Berger [13,14].…”

“…VHDs presumably represent lens fragments that are formed during phacoemulsification and accelerated through the zonula retro-capsular into the space of Berger [ 13 , 14 ]. Since decapsulated lens fragments provoke inflammation, VHDs presumably contribute to postoperative inflammation and thus macular thickening including CME [ 11 , 12 , 15 , 16 ]. So far, the relationship between VHDs and CME has been studied only retrospectively [ 11 , 12 ].…”

Active-fluidics versus gravity-fluidics system in phacoemulsification for age-related cataract (AGSPC): study protocol for a prospective, randomised, double-blind, controlled clinical trial

“…The advantages of the active-fluidics system in reducing CDE have been reported, and it remains to be further explored whether it will lead to a reduction in corneal endothelial damage 11 18. Observation of retinal thickness, particularly macular thickness, by OCT can help to figure out whether lesions such as macular oedema presents after cataract surgery and to develop targeted treatment early 36 37. Assessment of changes in RNFL thickness is also an important indicator to evaluate the effect of intraoperative perfusion pressure on the optic nerve 38 39…”