First Author: V.Rudenko RUSSIA
Co Author(s): E. Sorokin V. Egorov
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The postoperative macular edema (ME) after phacoemulsification (PE) is one of the severe complications of the anterior segment surgery. Long-term existence of ME leads to irreversible changes of the retinal pigment epithelium and photoreceptors and therefore to the irreversible visual loss. The analysis of risk factors of ME can help in its prognosis for careful observation of such patients and early surgical treatment which allows preventing severe visual loss. Purpose – to study the risk factors of tractional ME after PE of age-related cataract.
The research was performed in the State Institution Eye Microsurgery Complex named after academician S.N. Fyodorov, Khabarovsk, Russia
58 patients (58 eyes) with ME after PE in age of 55-83 years old were observed. The period of manifestation of ME was from 2 weeks to 6 months. The visual acuity varied from 0.01 to 0.6. The measurement of vitreoretinal interface was made by optical coherence tomography (STRATUS OCT model 3000, Carl Zeiss). The measurement of the axial length and horizontal diameter of the eyeball was made by the ultrasonic examination (A-scan) in all eyes. The shape of the eyeball was determined by the ratio of the axial length to the horizontal diameter of the eyeball. The shape with ratio from 0.98 to 1.02 was determined as the spherical, less than 0.98 – as the compressed ellipse, more than 1.02 – as the elongated ellipse. There was also made the retrospective analysis of the initial thickness of the native lens measured by A-scan before PE.
The central macular thickness was 209–823 μm (576.1±15 μm). There was partial posterior vitreous detachment (PVD) with adhesion to the retina in the foveal area in 43 eyes (74.1%). Broad vitreomacular adhesion (VMA) with thickening of the posterior hyaloid membrane and internal limiting membrane was observed in other 15 eyes (25.9%). Total PVD was not revealed in all cases. Multivariate analysis revealed the risk factors of the postoperative ME: short axial length (less than 23.5 mm), shape of the eyes of compressed ellipse, increased thickness of the native lens (more than 4.8 mm), stage of PVD, existence of VMA and the distance from the foveal centre to VMA.
These points may become the base of the prognosis of high risk of the appearance of tractional ME after PE of age-related cataract and planning of postoperative dynamic supervision of such patients.