<span>Impact of Existing Risk Factors and Surgical Events on Postoperative Cystoid Macular Edema in Cataract Surgery: OSOD Project <span>Results</span> </span>

Vollman, David

Impact of Existing Risk Factors and Surgical Events on Postoperative Cystoid Macular Edema in Cataract Surgery: OSOD Project Results

Saturday, April 26, 2014: 4:04 PM

Room 151A (Boston Convention and Exhibition Center)

David Vollman, MD, MBA, Washington University School of Medicine, St. Louis, MO, USA

Kate Blanquart, SIU School of Medicine, Belleville, IL, USA

Amy Chomsky, MD, Nashville VAMC, Nashville, Tennessee, USA

Mary K. Daly, MD, VA Boston Healthcare System, Boston, MA, USA

Elizabeth Baze, MD, Michael E. DeBakey VA Medical Center, Houston, TX, USA

Mary G. Lawrence, MD, MPH, DoD/VA Vision Center of Excellence, Arlington, VA, USA

Narrative Responses:

Purpose
To determine rates of cystoid macular edema after cataract surgery in correlation to various risk factors and surgical events.

Methods
Retrospective analysis of 4,924 cataract surgery cases from the VA Ophthalmic Surgical Outcomes Data (OSOD) Project. Outcomes analyzed included history of uveitis, history of macular edema, history of diabetic retinopathy, current topical prostaglandin analogs, pre-operative best corrected visual acuity, postoperative best corrected visual acuity, clinically significant macular edema on preoperative exam, diabetic retinopathy on preoperative exam, history of diabetes, HbA1C, type of procedure, conversion of procedure to large incision surgery, papillary expansion, trypan blue use, anterior vitrectomy, intraoperative floppy iris syndrome, posterior capsule tear, intraoperative vitreous prolapse, and postoperative cystoid macular edema. P-values were calculated using the Fisher exact test.

Results
111 patients (2.25%) developed post-operative cystoid macular edema. Of these, 4 (3.60%) (p<0.05) had history of uveitis; 26 (23.4%) (p=0.0001) had a history of diabetic retinopathy; 15 (13.5%) (p<0.000001) had a history of macular edema. Of these patients, 20 with a history of diabetic retinopathy had diabetic retinopathy on pre-operative ophthalmic exam (p=0.001), and 9 with a history of macular edema had macular edema on exam (p<0.0000005). Finally, development of POCME correlated with worse best corrected visual acuity outcomes: 20/41 for patients with POCME, compared with 20/23 for patients who did not develop POCME.

Conclusion
The development of postoperative cystoid macular edema is correlated with pre-existing risk factors: history of uveitis, history of macular edema, history of diabetic retinopathy, diabetic retinopathy on exam, macular edema on exam, and Type 2 diabetes. Patients who developed POCME showed poorer best corrected visual acuity, both pre- and postoperatively.