Jae Yong Kim

1
Case-control Study to Compare Surgical
Parameters of Postoperative Cystoid Macular
Edema Patients During Phacoemulsification

• Jae Yong Kim
• Bonnie An Henderson
• Sandra Lora Cremers
• Massachusetts Eye and Ear Infirmary
• Harvard Medical School
• Ophthalmic Consultants of Boston

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FINANCIAL DISCLOSURE

• This study was supported by
• Research to Prevent Blindness
• Massachusetts Lions Foundation
• Norman Knight Ophthalmology Fund
• Harvard Scholars Grant

3
INTRODUCTION

• Clinically significant cystoid macular edema
  (CME) occurs after 1-2 of cataract surgeries.1
• Angiographic CME is more common and may occur in
  up to 30 of cataract surgeries.1-2
• Peri-foveal capillary leakage has been attributed
  to inflammatory mediators and associated with
  previous history of uveitis and diabetes, and
  complications during cataract surgery.3
• As post-cataract CME is thought to be an
  inflammatory process, steroids and non-steroidal
  anti-inflammatory drugs (NSAIDs) are used for
  treatment.4

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PURPOSE

• To characterize surgical parameters such as
  effective phaco time (EPT), total surgical time,
  and infusion volume in postoperative CME
  patients.
• To compare them with those of non-CME controls
  retrospectively.

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METHODS

• 1659 cataract extraction cases performed by
  residents at the Comprehensive Ophthalmology
  Service at the Massachusetts Eye and Ear
  Infirmary between July 2001 and April 2006 were
  included.
• A database containing all cataract extraction
  cases was constructed.5
• The diagnosis of CME required both worsening of
  vision and fundoscopic, fluorescein angiographic,
  or optical coherence tomographic evidence of CME.
  

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METHODS

• 39 CME cases were diagnosed and surgical
  parameters were found in 27 of those 39 CME
  cases.
• Three fold age-, cataract severity-, and academic
  period- matched controls were selected.
• The severity of cataract was graded by the LOCS
  III system (Table 1).

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METHODS

• Age, preoperative and postoperative
  best-corrected visual acuity (BCVA), academic
  period when the surgery was performed, and the
  rate of preoperative and early postoperative
  topical NSAID use and intraoperative posterior
  capsular tear (PCT) and vitreous loss (VL) were
  investigated.
• Intraoperative surgical parameters such as EPT,
  total surgical time, and irrigating fluid volume
  were evaluated.
• Fisher exact and Student t-tests compared both
  groups.

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RESULTS

• The incidence of postoperative CME was 2.4
  (39/1659). 
• Only 27 CME cases were eligible with surgical
  parameters and 78 controls were included (Table
  2).

• There was no difference in age, cataract
  severity, and academic period between two groups
  (P0.48, 0.91, and 0.98 Table 3).

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RESULTS

• There was no statistical difference in EPT, total
  surgical time, and infusion volume between two
  groups (P0.90, 0.45, and 0.36 Table 4)

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RESULTS

• There was also no statistical difference in the
  preoperative BCVA and rate of preoperative
  topical NSAID use (P0.73, 0.45).
• There was no statistical difference in the rate
  of intraoperative PCT and VL between two groups
  (P1.00 and 1.00).

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RESULTS

• There was no statistical difference in the
  postoperative BCVA, improvement of BCVA, and the
  rate of early postoperative topical NSAID use
  (P0.35, 0.34, and 1.00).

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DISCUSSION

• The relationship between the incidence of
  post-cataract extraction CME and surgical
  parameters were investigated.
• We found that there was no relationship between
  higher usage of ultrasonic energy and development
  of post-cataract extraction CME with the Alcon
  Legacy in resident performed cataract surgery.
• Other modern phaco systems (AMO Sovereign with
  WhiteStar) may also have similar findings.
  Fishkind et al. have reported less EPT and phaco
  power but no difference in cell and flare after 1
  day and 3 months.6

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DISCUSSION

• Limitations of this study
• Retrospective nature.
• Unavailability of data regarding the early
  postoperative inflammation.
• Irregular intervals between surgery and
  postoperative follow-ups.

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CONCLUSION

• Surgical parameters such as EPT, total surgical
  time, and infusion volume seemed to have no
  effects on the incidence of postoperative CME.
• Further investigations are needed to define the
  relationships between intraoperative surgical
  parameters and development of CME.

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REFERENCES

• Wright PL, Wilkinson CP, Balyeat HD, et al.
  Angiographic cystoid macular edema after
  posterior chamber lens implantation. Arch
  Ophthalmol. 198810740-4.
• Gass JDM, Norton EWD. Follow-up study of cystoid
  macular edema following cataract extraction.
  Trans Am Acad Ophthalmol Otolaryngol.
  196973665-682.
• Flach AJ. Cyclo-oxygenase Inhibitors in
  Ophthalmology. Surv Ophthalmol. 199236259-284.
• Ray S, D'Amico DJ. Pseudophakic cystoid macular
  edema. Semin Ophthalmol. 200217167-180.
• Cremers, SL, Ciolino J, Ferrufino-Ponce ZK,
  Henderson BA. Objective Assessment of Skills in
  Intraocular Surgery (OASIS) Ophthalmology.
  20051121236-1241.
• Fishkind W, Bakewell B, Donnenfeld ED, et al.
  Comparative clinical trial of ultrasound
  phacoemulsification with and without the
  WhiteStar system. J Cataract Refract Surg.
  20063245-9.