Elsevier

Ophthalmology

Volume 123, Issue 2, February 2016, Pages 316-323
Ophthalmology

Original article
Risk Factors and Incidence of Macular Edema after Cataract Surgery: A Database Study of 81984 Eyes

https://doi.org/10.1016/j.ophtha.2015.10.001Get rights and content
Under a Creative Commons license
open access

Purpose

To define the incidence of pseudophakic macular edema (PME) after cataract surgery and to identify contributory risk factors.

Design

Retrospective database study of electronic medical records (EMRs).

Participants

A total of 81984 eyes undergoing cataract surgery between December 2010 and December 2014 from 8 independent United Kingdom clinical sites.

Methods

Structured clinical data mandated by the EMR were anonymized and extracted for each eye undergoing cataract surgery including: perioperative visual acuity, copathologic features, simultaneous surgical procedures, and the presence or absence of a specified list of intraoperative complications. Diabetic status with matched Early Treatment Diabetic Retinopathy Study (ETDRS) grading also was mandated by the EMR. Eyes receiving prophylactic nonsteroidal anti-inflammatory drugs were excluded.

Main Outcome Measure

Diagnosis of cystoid macular edema or new-onset macular edema in patients with diabetes, recorded by a healthcare professional within 90 days of surgery.

Results

Baseline incidence of PME in eyes without operative complications, diabetes, or risk factors was 1.17%. Eyes in which PME developed were more likely to be male, older, and to demonstrate risk factors. The relative risk (RR) was increased in eyes with capsule rupture with or without vitreous loss (RR, 2.61; 95% confidence interval [CI], 1.57–4.34), a previous diagnosis of epiretinal membrane (RR, 5.60; 95% CI, 3.45–9.07), uveitis (RR, 2.88; 95% CI, 1.50–5.51), retinal vein occlusion (RR, 4.47; 95% CI, 2.56–5.92), or retinal detachment repair (RR, 3.93; 95% CI, 2.60–5.92). High myopia, age-related macular degeneration, or prostaglandin analog use were not shown to increase risk. Eyes with PME on average had poorer postoperative visual acuity, which persisted to the latest time point assessed, up to 24 weeks. Eyes from patients with diabetes, even in the absence of retinopathy, had an increased RR (RR, 1.80; 95% CI, 1.36–2.36) of new macular edema after surgery. The risk was higher in the presence of any diabetic retinopathy (DR; RR, 6.23; 95% CI, 5.12–7.58) and rose proportionately with increasing severity of DR.

Conclusions

Pseudophakic macular edema occurs commonly after phacoemulsification cataract surgery, even in the absence of complications and risk factors. This large retrospective study using structured EMR data quantified the RRs of PME and the risk with increasing ETDRS severity of DR. It highlights the need for prophylactic therapy, especially in those groups of eyes with the highest RRs.

Abbreviations and Acronyms

CI
confidence interval
CSME
clinically significant macular edema
DR
diabetic retinopathy
EMR
electronic medical record
ETDRS
Early Treatment Diabetic Retinopathy Study
IOP
intraocular pressure
NPDR
nonproliferative diabetic retinopathy
NSAID
nonsteroidal anti-inflammatory drug
OCT
optical coherence tomography
PDR
proliferative diabetic retinopathy
PME
pseudophakic macular edema
RR
relative risk
VA
visual acuity

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Supplemental material is available at www.aaojournal.org.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Supported by the National Institute for Health Research (academic clinical lecturer support to C.J.C). Alcon (Fort Worth, TX) provided financial support with a research grant to cover the cost of data extraction and open access but did not play any role in the design or conduct of the study and did not have any input into the preparation and content of the manuscript. Robert Johnston is the Medical Director of Medisoft Limited, the EMR supplier to each contributing site and Medisoft was funded to perform the data extraction.

Author Contributions:

Conception and design: Johnston, Chu, Sallam, Mohamed, Yang

Analysis and interpretation: Johnston, Chu, Yang

Data collection: Johnston, Chu, Buscombe, Yang

Obtained funding: none

Overall responsibility: Johnston, Chu, Buscombe, Sallam, Mohamed, Yang

The full details of contributors to the UK Pseudophakic Macular Edema Study Group are listed online in the Appendix.