Risk Factors and Incidence of Macular Edema after Cataract Surgery

Chu, Colin J; Johnston, Robert L.; Buscombe, Charlotte; Sallam, Ahmed; Mohamed, Queresh; Yang, Yit

doi:10.1016/j.ophtha.2015.10.001

Cited by 330 publications

(315 citation statements)

References 22 publications

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“…In the context of cataract surgery, we have recently reported on a multicentre database study of 81 984 eyes undergoing cataract surgery in the UK 9. The UK National Health Service (NHS) is an ideal setting for this study, because it serves more than 90% of the population for cataract surgery, and there has been widespread adoption of EMR systems that mandate collection of detailed standardised datasets developed by The Royal College of Ophthalmologists 10 11.…”

Section: Introductionmentioning

confidence: 99%

Cataract surgery in uveitis: a multicentre database study

Chu

Dick

Johnston³

et al. 2017

Br J Ophthalmol

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SUBTITLE (35 words):Demographics, surgical factors and outcomes from 1173 eyes with uveitis undergoing cataract surgery were compared to control eyes using electronic medical records, which highlighted the increased complexity and management requirements of this patient group. AUTHORS: CORRESPONDING AUTHOR:Alastair K Denniston (Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. a.denniston@bham.ac.uk) KEYWORDS:Uveitis, cataract, phacoemulsification, real-world, database. WORD COUNT: (2866 post-revision) in main text STRUCTURED ABSTRACT (250 words): "Background/aims"Cataract is an important source of visual loss in patients with uveitis. Whether or not outcomes of cataract surgery in eyes with uveitis are worse compared to non-uveitic eyes have to date been compromised by lack of reliable estimates of benefit and harm, which require data from large cohorts. "Methods"Electronic medical record data were extracted from eight independent UK clinical sites for eyes undergoing cataract extraction between January 2010 and December 2014. 1173 eyes with a recorded diagnosis of uveitis were compared to a reference group of 95573 eyes from the same dataset. "Results"Uveitic eyes represented 1.2% of all eyes undergoing cataract surgery. Eyes in the uveitic group had worse pre-operative visual acuity (0.87 vs 0.65 logMAR units), were from younger patients and had shorter axial lengths and a higher incidence of ocular co-pathology including glaucoma. A greater number had documented small pupils, required additional surgical procedures, developed more intraoperative complications and had poorer post-operative visual acuity at all timepoints measured up to 6 months (0.41 vs 0.27 logMAR units at 12-24 weeks). "Conclusion"This large study cohort of eyes with a diagnosis of uveitis undergoing cataract surgery highlights more precisely the complex surgical demands, co-pathology and worse visual outcomes in this group. This data will allow more accurate pre-operative counselling and planning. Although improvement in visual acuity is achieved in most cases, prognosis should be guarded so patient expectations are met. Compared to the non-uveitic population, the mean post-operative visual acuity is between one to two lines worse at all time-points. INTRODUCTION:Cataract is a major cause of visual loss in patients with uveitis; up to 40% of the visual loss is either solely or largely due to cataract [1]. Surgical treatment may be effective but is associated with higher complication rates than in eyes without previous uveitis. Quantifying this risk is important in order to inform patients and surgeons as to the likely short-and long-term benefit or harm of undertaking cataract surgery, and may affect the timing of such surgery.Currently most data on cataract surgery in patients with uveitis comes from small case series or cohort studies, with data gathered over long time periods to attain sufficient numbers. As this may be so long that practice changes, the studies may not reflect current prac...

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Section: Introductionmentioning

confidence: 99%

Cataract surgery in uveitis: a multicentre database study

Chu

Dick

Johnston³

et al. 2017

Br J Ophthalmol

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“…Being diabetic increased the risk to 1.8 times, and having Diabetic Retinopathy (DR) increased the risk to 6.23 times. A greater chance of ME development was seen with increasing severity of DR 11. Kwon SI et al showed that 18% of diabetic patients developed transient ME, with 68% showing resolution after 6 months of surgery 2…”

Section: Discussionmentioning

confidence: 99%

Effect of topical nepafenac in prevention of macular edema after cataract surgery in patients with nonproliferative diabetic retinopathy

Sarfraz¹,

Haq²,

Mehboob³

2017

Pak J Med Sci

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Objective:To determine the efficacy of topical Nepafenac (0.1%), administered post-operatively in prevention of Macular Edema (ME), after cataract surgery in patients with Non-Proliferative Diabetic Retinopathy (NPDR).Methods:This randomized control trial was conducted at Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi from Sep 2015 to Sep 2016. Sixty eyes of 60 patients with NPDR underwent phacoemulsification with intraocular lens implantation. Group 1 received 0.1% Nepafenac, 8-hourly, in operated eye after cataract surgery for three months, along with routine post-operative medications. Group-2 received only routine post-operative medications. ME was defined as increase in Central Macular Thickness (CMT) of >10% from pre-operative baseline, measured using spectral domain optical coherence tomography.Results:Mean age of study population was 60.97±4.91 years. Out of 60 patients, 34 (56.7%) were males and 24 (43.3%) were females. Mean pre-operative CMT, 3 months post-operative CMT, mean change in CMT and mean frequency change in CMT of Group-1 was 226.5±10.86µm, 228.83±14.56 µm, 2.33±10.45 µm and 1.05% respectively. Mean pre-operative CMT, three months post-operative CMT, mean change in CMT and mean frequency change in CMT in Group-2 was 223.93±11.69µm, 236.17±16.16 µm, 12.23±12.40µm and 5.51% respectively. ME was observed in one patient (3.3%) in Group-1, and seven patients (23.3%) in Group 2. The difference of mean change in CMT and frequency change in CMT between groups was statistically significant (p<0.05).Conclusion:0.1% topical Nepafenac is effective in prevention of macular edema after cataract surgery in patients with non-proliferative diabetic retinopathy (NPDR).

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“…The pathogenesis of this syndrome reported to be multifactorial. Its incidence is higher in patients with vasculopathy, hypertension, uveitis [2][3][4]. IrvineGass syndrome is usually self-limiting and spontaneous resolution occurs within 3-6 months [5].…”

Section: Introductionmentioning

confidence: 99%

The management of Irvine-Gass Syndrome in a patient using Inhaler Steroid

Altintas¹

2018

Int J Clin Exp Ophthalmol

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Irvine-Gass syndrome, is one of the most common causes of painless decrease in vision following even uneventful cataract surgery. It usually responds well to medical therapy, but, there are no widely acceptedconsensus on the effi cacy of various therapeutic options for the treatment of Irvine-Gass syndrome. The patient presenting in this case report, has systemic hypertension and chronic obstructive pulmonary disease and he use oral anti-hypertension medication and inhaler steroid. He diagnosed as Irvine-Gass syndrome due to presence of decrease in visual acuity and macular edema with hyporefl ective cystic intraretinal spaces in optical coherence tomography (OCT) since4th weekcontrol visitfollowing uneventful cataract surgery. After the responsiveness of several medications including topical steroid and non-steroidal anti-infl ammatory drugs and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), intravitreal sustainedrelease dexamethasone implant was applied. The visual acuity improved to 0.00 logMAR at 1st month after intravitreal dexamethasone therapy and consecutive OCT images showed complete resolution of macular edema with a normalization of the foveal profi le.The visual acuity and foveal architecture remained stable in 2-year follow-up period and additional treatment was not needed. To the best of our knowledge, this is the fi rst reportthatmentions the increment of visual acuity after a single dexamethasone implant, even though it did not response anti-VEGF combined with topical steroid and non-steroidal anti-infl ammatory drugs.

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Risk Factors and Incidence of Macular Edema after Cataract Surgery

Cited by 330 publications

References 22 publications

Cataract surgery in uveitis: a multicentre database study

Cataract surgery in uveitis: a multicentre database study

Effect of topical nepafenac in prevention of macular edema after cataract surgery in patients with nonproliferative diabetic retinopathy

The management of Irvine-Gass Syndrome in a patient using Inhaler Steroid

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