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

详细信息    查看全文

• 作者：Colin J. Chu ; PhD¹ ; Robert L. Johnston ; FRCOphth² ; ^{Rob.Johnston@glos.nhs.uk" class="auth_mail" title="E-mail the corresponding author} ; Charlotte Buscombe ; MRCP² ; Ahmed B. Sallam ; FRCOphth² ; ³ ; Queresh Mohamed ; FRCOphth² ; Yit C. Yang ; FRCOphth⁴ ; ⁵ ; for the United Kingdom Pseudophakic Macular Edema Study Group^&lowast ;
• 关键词：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
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：123
• 期：2
• 页码：316-323
• 全文大小：1231 K

文摘

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.