Improving visual outcomes by preserving outer retina morphology in eyes with resolved pseudophakic cystoid macular edema

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• 作者：Allan A. Hunter ; MD ; ^{hunter.allan.a@gmail.com" class="auth_mail}Author Vitae ; Sara P. Modjtahedi ; MD ; Kuumba Long ; MD ; Robert Zawadzki ; PhD ; Eric K. Chin ; MD ; Jeffrey J. Caspar ; MD ; Lawrence S. Morse ; MD ; PhD ; David G. Telander ; MD ; PhD
• 刊名：Journal of Cataract and Refractive Surgery
• 出版年：April, 2014
• 年：2014
• 卷：40
• 期：4
• 页码：626-631
• 全文大小：1138 K

文摘

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Purpose

To use ultra-high-resolution optical coherence tomography (OCT) subclinical anatomic alterations to explain suboptimum vision despite pseudophakic cystoid macula edema (CME) resolution.

Setting

University of California-Davis, Sacramento, California, USA.

Design

Case study.

Methods

This study comprised patients who had cataract phacoemulsification surgery. Cases聽of resolved postoperative CME (diagnosed postoperatively by 1 month and resolved by 1聽year) were included. Exclusion criteria included any other cause for decreased vision or compounding factors. Patients with a history of resolved pseudophakic CME were imaged using a purpose-built ultra-high-resolution OCT system with 4.5 渭m axial resolution and an acquisition speed of聽9聽frames/sec (1000 A-scans/frame). The corrected distance visual acuity (CDVA) was determined by Early Treatment Diabetic Retinopathy Study standards. Statistical analysis was by the unpaired t test. A P value less than 0.05 was considered significant.

Results

The review identified 56 patients with a pseudophakic CME diagnosis at least 1 month postoperatively. Fifteen eyes (26.8%) had less than 20/20 CDVA despite resolution of CME; 7 participated. Four patients with 20/20 CDVA after resolution of pseudophakic CME participated. Eyes with reduced CDVA after macula edema showed ultra-high-resolution OCT evidence of blurring of outer segments of photoreceptors, while controls showed normal outer retina morphology (P < .05).

Conclusions

Persistent anatomic alteration of photoreceptors visualized by ultra-high-resolution OCT correlated with reduced CDVA in patients with pseudophakic CME compared with patients who had 20/20 CDVA after macula edema. This anatomic alteration in outer photoreceptor morphology is a plausible explanation for the reduced CDVA in this disease.

Financial Disclosure

No author has a financial or proprietary interest in any material or method mentioned.