Impact of prior pars plana vitrectomy on development of cystoid macular edema after uneventful cataract surgery

• Published in: Journal of cataract and refractive surgery Vol. 49; no. 3; pp. 266 - 271
• Main Authors: Du, Jeanette, Landa, Gennady
• Format: Journal Article
• Language: English
• Published: Maryland, MD Wolters Kluwer 01.03.2023
• Subjects: Cataract - complications; Cataract Extraction - adverse effects; Humans; Macular Edema - etiology; Postoperative Complications - surgery; Retinal Detachment - surgery; Retrospective Studies; Vitrectomy - methods
• ISSN: 0886-3350; 1873-4502; 1873-4502
• DOI: 10.1097/j.jcrs.0000000000001097

History of rhegmatogenous retinal detachment repaired by pars plana vitrectomy with gas tamponade was associated with an increased incidence of pseudophakic after uneventful cataract surgery. Purpose:To investigate whether a history of prior pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) predisposes to the development of pseudophakic cystoid macular edema (CME).Setting:New York Eye and Ear Infirmary of Mount Sinai, New York, New York.Design:Retrospective cohort study.Methods:Records of 365 subjects who underwent PPV for RRD and subsequent cataract surgery between 2017 and 2020 were reviewed. Patients with a history of diabetic retinopathy, inflammatory retinal vascular disease, uveitis, advanced age-related macular degeneration, intraocular infection, myopic maculopathy, or significant intraoperative complications precluding posterior chamber intraocular lens placement were excluded. Age-matched subjects who underwent routine cataract surgery served as controls. Clinical data and macular optical coherence tomography (OCT) findings up to 4 years postoperatively were obtained.Results:54 eyes underwent uneventful cataract surgery by phacoemulsification and had a history of PPV with gas tamponade. 55 eyes underwent uneventful cataract surgery only. The average follow-up time after cataract surgery was 39.1 months. In eyes with a history of PPV, the incidence of OCT-detected CME was 27.8% (15/54) compared with 3.8% (2/55) in the control group (P < .001) and the incidence of clinically significant CME was 18.5% (10/54) compared with 1.8% (1/55) in the control group (P = .004). 80% (12/15) of CME cases were treated with topical therapy, and none required intravitreal injection.Conclusions:Prior PPV for RRD is associated with an increased incidence of pseudophakic CME after uneventful cataract surgery. Prophylactic or prolonged postoperative anti-inflammatory topical therapy may be prudent to consider in these patients.