Cystoid Macular Edema after Rhegmatogenous Retinal Detachment Repair with Pars Plana Vitrectomy: Rate, Risk Factors, and Outcomes

Abstract

(1) Background: The aim was to describe the rate and outcomes of cystoid macular edema (CME) after pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify risk factors and imaging characteristics. (2) Methods: A retrospective consecutive case study was conducted over a 5-year period among adult patients who underwent PPV for primary RRD repair. The main outcome measure was the rate of CME at 12 months following PPV. (3) Results: Overall, 493 eyes were included. The CME rate was 28% (93 patients) at 12 months. In multivariate analysis, eyes with worse presenting visual acuity (VA) (odds ratio [OR], 1.55; 95% CI, 1.07–2.25; p = 0.02) and grade C proliferative vitreoretinopathy (PVR) (OR, 2.88; 95% CI, 1.04–8.16; p = 0.04) were more at risk of developing CME 1 year after PPV. Endolaser retinopexy was associated with a greater risk of CME than cryotherapy retinopexy (OR, 3.06; 95% CI, 1.33–7.84; p = 0.01). Eyes undergoing cataract surgery within 6 months of the initial RRD repair were more likely to develop CME at 12 months (OR, 1.96; 95% CI, 1.06–3.63; p = 0.03). (4) Conclusions: CME is a common complication after PPV for primary RRD repair. Eyes with worse presenting VA, severe PVR at initial presentation, endolaser retinopexy, and cataract surgery within 6 months of initial RRD repair were risk factors for postoperative CME at 12 months.

Risk Factors of Cystoid Macular Edema After Pars Plana Vitrectomy for Pseudophakic Retinal Detachment

“…In the present study, a multivariate analysis showed two independent risk factors associated with the occurrence of CME, in particular the presence of severe PVR and the use of laser retinopexy. Our results are consistent with previous studies that investigated the development of CME after PPV showing that PVR is one of the major risk factors involved [17][18][19]. Additionally, three studies that exclusively included RRD with severe stages of PVR showed higher rates of CME, ranging from 33% to 52% [20][21][22].…”

“…To date, few authors evaluated the prevalence and risk factors of postoperative CME after n number, M male, F female, CME cystoid macular edema RRD repair with PPV [18]. Recently, three studies showed a prevalence between 10% 17% of patients undergoing PPV [17][18][19]. Our results are in agreement with those reported.…”

“…Additionally, three studies that exclusively included RRD with severe stages of PVR showed higher rates of CME, ranging from 33% to 52% [20][21][22]. This finding confirms the role of inflammation as a leading process involved in CME development since PVR occurs in response to tissue damage caused by RRD and subsequent inflammatory reaction [19,23,24]. It has been shown that several inflammatory cells and cytokines, such as interleukin (IL)-1, IL-6, tumor necrosis factor alpha (TNFa), interferon gamma (IFNc), and intercellular adhesion molecule 1 (ICAM-1), are involved in PVR development [25][26][27][28].…”

“…Thus, the cause of the CME can be difficult to identify, as it can be consecutive either to RRD or to subsequent cataract surgery. Indeed, Merad et al demonstrated that cataract surgery performed within 6 months of PPV for RRD was significantly associated with CME in multivariate analysis [19]. Furthermore, Starr et al showed that the most important risk factors for CME following RRD repair were subsequent cataract surgery and recurrent RRD [18].…”

Two-Port “Dry Vitrectomy” as a New Surgical Technique for Rhegmatogenous Retinal Detachment: Focus on Macula-on Results

“…In fact, recent studies have highlighted that the incidence of CME after rhegmatogenous retinal detachment repair was higher in patients who underwent PPV, either alone or combined with phacoemulsification than in those treated with SB [ 29 ]. Probably, the use of cryotherapy retinopexy instead of endolaser retinopexy [ 30 ] plays a role in lowering the risk of post-operative CME.…”