Session Title: Vitreoretinal Surgery III
Session Date/Time: Friday 12/09/2014 | 08:00-10:00
Paper Time: 09:28
Venue: Boulevard E
First Author: : I.Dooley UK
Co Author(s): : H. Laviers H. Zambarakji
Cystoid macular edema (CME) may be symptomatic or detected by OCT (OCT-evident CME). The reported incidence of symptomatic CME post routine phacoemulsification (PE) is relatively low (0.1 to 2.35%), but ocular coherence tomography (OCT)-evident CME is considerably higher at 4 to 11%. The CMO incidence would seem to be higher for posterior segment procedures ranging from1.9% to 26%. We postulate that the timing of PE relative to PPV is an important risk factor for CME. We aim to report the rates of OCT-evident and symptomatic CME in patients undergoing PPV preceded by, followed by and concurrent with PE.
Eye Treatment Centre, Barts Health, Whipps Cross University Hospital, London, United Kingdom
We report a retrospective study of 43 eyes in 43 patients who underwent PPV and ILM peeling for FTMH. All patients with retinal vascular occlusions, diabetes and previous uveitis were excluded. Patients underwent 20 gauge (n = 11) or 23 gauge (n = 32) PPV. PE was a standard clear corneal incision with phaco/chop technique. All procedures were performed by a single surgeon (HJZ) between 2008 and 2012. All patients received dexamethasone (0.1%) topical regime four times per day in the operated eye after every procedure. Patients with CME had at least one cyst within the OCT field associated with increased central macular thickness (CMT).
CME was noted in 6/43 patients (14%). All CME resolved with 6 weeks of topical non-steroidal anti-inflammatories and topical steroids followed by a tapering period. OCT-evident CME occurred in 3/8 eyes (38%) that had PE post-PPV ILM-peel compared to 0/8 (0%) of the phakic group, 2/18 (11%) of the combined group and 1/9 (11%) of the PPV ILM peel post PE group, respectively. Symptomatic CME occurred in 2/8 eyes (25%) that had PE post-PPV ILM-peel compared to 0/8 (0%) of the phakic group, 1/18 (6%) of the combined group and 1/9 (11%) of the PPV ILM-peel post PE group, respectively. The mean (standard deviation) LogMAR best-corrected mean visual acuity (BCVA) improved from 0.44 (± 0.27) at time of CME diagnosis to 0.35 (± 0.19), with a mean decrease in CMT from 392.2 (± 102.5) µm to 287.7 (± 34.0) µm. Three patients developed symptomatic recurrent CME between 9 and 12 months postoperatively, which resolved with further topical regime. Two of the latter patients had PPV ILM peel followed by PE, the remaining patient had PE followed by PPV ILM peel.
We report a higher incidence of CME (OCT-evident, symptomatic and recurrent) in vitrectomised ILM-peeled eyes when PE is performed subsequent to PPV, than for any other sequences of PPV with PE. While a beneficial effect ILM peeling has been reported upon CME, this effect may be reduced or lost in the setting of inflammation post PE. The nature and cause of the inflammatory response are subject to discussion.