Risk of Pseudophakic Cystoid Macular Edema in Fellow-Eye Cataract Surgeries: A Multicenter Database Study.

PURPOSE: To quantify the risk of pseudophakic cystoid macular edema (pCME) in fellow-eye cataract surgery and to determine risk factors, including prior first-eye pCME. DESIGN: Retrospective, clinical database study. PARTICIPANTS: Patients undergoing bilateral nonsimultaneous cataract surgeries in 8 UK National Health Service clinical centers between July 2003 and March 2015. METHODS: We excluded patients with a history of diabetic macular edema (DME) or CME and perioperative topical nonsteroidal anti-inflammatory drug use in either eye. We calculated the overall risk of pCME and used Poisson model with robust estimation of standard error to identify potential risk factors for pCME in the fellow eye. MAIN OUTCOME MEASURE: The risk of postoperative clinical pCME in the fellow eye. RESULTS: A total of 54 209 patients were included. The mean age was 74.6 ± 10.4 years, and 38.8% were male. The fellow eye developed pCME in 544 patients (1%). The risk of fellow-eye pCME among patients without first-eye pCME was 0.9%. However, the risk of fellow-eye pCME among those with first-eye pCME was 10.7%. In the fully adjusted model, we found that the risk factors for the development of fellow-eye pCME were first-eye pCME (RR, 8.55, 95% confidence interval [CI], 6.19-11.8), epiretinal membrane (ERM) (RR, 4.1, CI, 2.63-6.19), history of retinal vein occlusion (RR, 2.94, CI, 1.75-4.93), diabetes without history of DME (RR, 2.08, CI, 1.73-2.5), advanced cataract (RR, 1.75, CI, 1.16-2.65), prostaglandin analogue use preoperatively (RR, 1.49, CI, 1.13-1.97), and male sex (RR, 1.19, CI, 1.0-1.41). CONCLUSIONS: History of pCME in the first-operated eye is the strongest independent risk factor for the development of pCME in the fellow eye. Our findings may guide clinicians in counseling patients on the risk of pCME before performing cataract surgery in the fellow eye and help in identifying high-risk patients who may benefit from prophylactic therapy. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Cystoid Macular Edema after Cataract Surgery in the United States: IRIS® Registry (Intelligent Research in Sight) Analysis.

PURPOSE: To determine the incidence, risk factors, and visual outcomes of cystoid macular edema (CME) after cataract surgery in the United States. DESIGN: Retrospective, longitudinal, case-control study. PARTICIPANTS: Patients aged ≥ 18 years who underwent phacoemulsification cataract surgery. METHODS: The American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) was used to analyze patients who underwent cataract surgery between 2016 and 2019. Patients who received a diagnosis of CME within 90 days after cataract surgery were classified as cases, and the rest were classified as controls. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors associated with the development of CME as well as poor visual outcome (defined as a best-recorded visual acuity worse than 20/40 Snellen equivalent at postoperative month 12). MAIN OUTCOME MEASURES: Incidence, demographics, baseline characteristics, and visual outcomes. RESULTS: Of 3.1 million cataract surgeries performed during the study period, CME was diagnosed in 25 595 eyes (0.8%), with an average onset of 6 weeks. Patients with CME were more likely to be male, to be aged < 65 years, to be Black, and to have preexisting diabetic retinopathy. Patients with CME were more likely to have a poor visual outcome (OR, 1.75; 95% CI, 1.66-1.84; P < 0.001), with a mean best-recorded visual acuity of 20/30 at postoperative month 12 (compared with 20/25 for those without CME; P < 0.001). Other factors associated with a poor visual outcome included smoking, Medicaid insurance, non-White race, and baseline ocular comorbidities such as macular degeneration and retinal vein occlusion. CONCLUSIONS: Although the incidence of CME after cataract surgery is low and most eyes achieve a visual acuity of 20/40 or better, there are significant outcome disparities that warrant further exploration. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Systemic immune-inflammation index could be associated with pseudophakic cystoid macular edema after an uneventful phacoemulsification surgery in patients without risk factors.

BACKGROUND: To evaluate the association between serum biomarkers and pseudophakic cystoid macular edema (PCME) in eyes without risk factors after uneventful phacoemulsification cataract surgery. METHODS: This is a case-control study. Patients without risk factors and who developed clinically significant PCME after uncomplicated phacoemulsification surgery were enrolled in the study. The age- and sex-matched control group that had normal fundus examination findings and 10/10 visual acuity in the first week, first month and following postoperative control visits was randomly recruited from the same study cohort. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were obtained from the preoperative complete blood count (CBC) test and compared between the two groups. Linear regression analysis was used to assess the relationship between central macular thickness (CMT) and biomarkers. A binary logistic regression model was generated to evaluate the significance of the biomarkers in predicting PCME. The receiver operating characteristic (ROC) curves of the significant parameters in the logistic regression model were presented to detect the area under the curve (AUC), the cut-off point, the sensitivity and the specificity. RESULTS: The study cohort included 5352 patients. Of these patients, 52 (0.97%) met the inclusion criteria, and 60 age- and sex-matched patients were recruited as the control group. PLR, NLR, and SII were significantly different between the two groups (p = 0.006, p = 0.002, p < 0.001, respectively). According to the linear regression analysis, SII was found to have a significant relationship with CMT (p < 0.001). Only SII was assessed as significant in the logistic regression model (p = 0.046). In the ROC curve, the AUC of SII was 0.709. The sensitivity and specificity of SII for PCME prediction were 65.38% and 75%, respectively, and the cut-off point was 433.70. CONCLUSION: SII is associated with the occurrence of PCME in eyes without risk factors after uneventful phacoemulsification surgery. SII could be a useful tool to predict PCME in eyes without risk factors.

Efficacy of topical dexamethasone eye drops in preventing ocular inflammation and cystoid macular edema following uncomplicated cataract surgery with or without injection of a single dose perioperative subtenon triamcinolone acetonide.

PURPOSE: To evaluate the efficacy and safety of topical dexamethasone (DEX) eye drops in combination with a single perioperative subtenon triamcinolone acetonide (sTA) injection versus conventional topical DEX eye drops in the prevention of ocular inflammation and cystoid macular edema following cataract surgery. MATERIALS AND METHODS: Medical records of 245 eyes of 245 patients who underwent uncomplicated cataract surgery were analyzed in this retrospective controlled clinical study. Topical DEX eye drops were administered to 128 eyes routinely postoperatively, and 117 eyes were given a single dose of sTA (40 mg/ml) together with topical DEX eye drops for postoperative care. Postoperative topical antibiotic prophylaxis was applied to all eyes. The primary outcomes were anterior chamber (AC) cells and flare, central macular thickness (CMT), best corrected visual acuity (BCVA), and intraocular pressure (IOP) measurements on day 7, day 30, day 90, and day 180 following surgery. RESULTS: Although CMT increased in the DEX group, no increment was observed in the DEX + sTA treated group for all follow-up periods (on day 7 (+1.3 ± 18.6 and -8.7 ± 21.9 µm, p = 0.038), on day 30 (+20.5 ± 58.4 and -4.1 ± 25.2 µm, p = 0.009), on day 90 (+7.2 ± 19.9 and -5.7 ± 30.6 µm, p = 0.029), and on day 180 (+8.2 ± 22.6 and -6.4 ± 32.9 µm, p = 0.032)). There was no significant difference in terms of AC cells and flare between the two groups during the entire follow-up period (p > 0.05). Significant improvement in BCVA was observed in the DEX + sTA group at day 30 (p = 0.008). IOP differences were comparable, and both groups had high ocular tolerance. There were no severe adverse effects recorded. CONCLUSIONS: Topical DEX eye drops in combination with single dose perioperative injection of sTA have robust efficacy in preventing ocular inflammation and the development of cystoid macular edema following uncomplicated cataract surgery.

Subfoveal Choroidal and Macular Thickness Changes after Phacoemulsification Using Enhanced Depth Imaging Optical Coherence Tomography.

PURPOSE: To assess changes in the thickness of the subfoveal retina and choroid after phacoemulsification using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: A prospective study was conducted on 100 patients. The subfoveal choroidal thickness (SFCT) was measured at 7 points and the retinal thickness was measured at 5 points (before surgery, and 1 day, 1 week, 1 month, and 3 months after surgery). RESULTS: The foveal choroidal thickness showed a thickening trend (but p > 0.05). Compared to the change from baseline to day 1, the changes from baseline were significantly different at nasal 3 mm and 6 mm at all other time points (all p < 0.05). Choroidal thickness changes at temporal 6 mm correlated negatively with intraocular pressure (IOP) at 1 week and 1 month; changes at nasal 3 mm correlated negatively with IOP at 1 week and 1 month (all p < 0.05); changes at nasal 3 mm, temporal 3 mm, and temporal 6 mm correlated with average ultrasonic energy. Choroidal thickness changes correlated with ultrasound (US) time at day 1. CONCLUSIONS: Uncomplicated phacoemulsification led to changes in choroidal thickness. IOP and choroidal thickness changes were negatively correlated. The foveal retinal thickness was correlated with age. SFCT was correlated with sex, axial length, IOP, and US time.

Bilateral effect following off label unilateral intravitreal brolucizumab injection in patient with pseudophakic cystoid macular edema.

PURPOSE: To report a bilateral reduction in pseudophakic cystoid macular edema (PCME) after unilateral intravitreal injection (IVI) of brolucizumab. OBSERVATIONS: A 64-year-old female with bilateral recalcitrant PCME was treated with one dose of intravitreal ozurdex implant and triamcinolone acetonide each in both the eyes, with an equivocal response. On switching to IVI brolucizumab in the right eye (OD), the patient showed significant improvement in the best-corrected visual acuity (BCVA) with a notable reduction in the intraretinal fluid (IRF) and central subfield thickness (CST) in both the eyes at one month. CONCLUSIONS AND IMPORTANCE: In conclusion, IVI brolucizumab is effective for the management of recalcitrant PCME with good visual and anatomical outcomes at one month. However, this molecule can also have therapeutic efficacy in the uninjected eye possibly due to systemic escape. More research into the pharmacokinetic properties of this novel molecule is needed to validate our findings.

Peripapillary retinal nerve fiber layer thickness as a diagnostic tool for pseudophakic cystoid macular edema.

PURPOSE: To investigate the effects of pseudophakic cystoid macular edema (PCME) on retinal nerve fiber layer (RNFL) thickness before and after treatment using optical coherence tomography (OCT). METHODS: A retrospective, observational study of consecutive patients diagnosed with PCME after cataract surgery. Patients underwent macular and RNFL OCT imaging at time of diagnosis and during follow up. OCT was performed for both the study eye and the contralateral healthy eye which served as control. All patients were followed for a period of at least 6 months. RESULTS: Overall, 40 eyes of 40 patients with a mean age of 71.1 ± 8.1 years of which 45% (n = 18) were of male gender were included in this study. At presentation, the central thickness in the PCME eye was significantly higher than in the contralateral eye (515.7 ± 127.9µm versus 238.1 ± 41.8µm, p < 0.001). Similarly, all macular measurements were significantly higher in the PCME eye compared to the contralateral eye (p < 0.001 for all). In terms of RNFL measurements, the PCME eyes had greater global (p < 0.001), superonasal (p = 0.001) and superotemporal (p = 0.005) thickness values. PCME eyes demonstrated a significant decrease in thickness for all macular and RNFL parameters following resolution of CME (p < 0.05 for all). CONCLUSIONS: PCME patients presents with greater global, superotemporal and superonasal RNFL thickness in comparison to the other healthy eye. After resolution of PCME, there is significant thinning of RNFL. Peripapillary RNFL thickness may serve as an additional parameter for diagnosis and follow-up of PCME.

Topical and Subcutaneous Interferon-Alpha for the Treatment of Refractory Inflammatory Macular Edema.

PURPOSE: To evaluate the efficacy of topical interferon alpha-2b (tIFN a2b) and subcutaneous pegylated interferon alpha-2a (peg-IFN a2a) in the treatment of refractory pseudophakic (PME) and uveitic (UME) macular edema. METHODS: Retrospective case series of patients with PME or UME that was non-responsive to conventional therapies. Topical IFN a2b drops (1 MIU/ml) were commenced four times a day. Non-responders were offered treatment with subcutaneous peg-IFN a2a starting at 180 mcg weekly. RESULTS: Seven eyes of seven patients (three UME and four PME) were treated with tIFN a2b. Three eyes had complete ME resolution with tIFN treatment after a mean of 2.66 weeks (range 1-4 weeks) and no recurrence after a mean total course of 11.33 weeks (range 5-20 weeks). Two cases (both PME) had partial responses to tIFN treatment and two cases (both UME) failed to respond. Of the four eyes that incompletely responded to tIFN (treatment range 6 weeks to 4 months), three were treated with peg-IFN a2a, which invariably led to complete and sustained ME resolution. Adverse effects from topical treatment were mild and consisted mainly of superficial irritation. Adverse effects of subcutaneous treatment included nausea, vomiting, anorexia, and leukopenia, though none limited treatment. CONCLUSIONS: Topical IFNa-2b appears safe and effective in isolation or in conjunction with topical steroids for the treatment of inflammatory macular edema (IME) in about half of patients in our small series. All partial and non-responders had complete disease resolution with systemic IFN. Topical IFN a2b should be considered in patients with refractory IME.

Role of nonsteroidal anti-inflammatory drugs on change in macular volume postcataract surgery in diabetic eyes: A retrospective comparative study.

CONTEXT: Diabetic eyes suffer from variety of complications including macular edema. Cataract surgery is the most commonly done procedure throughout the world and majority would be diabetics. As pseudophakic-cystoid macular edema (CME) is a known complication following cataract surgery, our study concentrated on finding the role of prophylactic topical nonsteroidal anti-inflammatory drugs (NSAIDs) on change in total macular volume (TMV) postcataract surgery in diabetic eyes. AIMS: To evaluate the role of NSAIDs on change in TMV postcataract surgery in diabetic eyes. SETTINGS AND DESIGN: Retrospective comparative study. SUBJECTS AND METHODS: Data were collected from the medical records department of our institute constituting diabetics undergoing cataract surgery from June-2021 to February-2022. Eighty diabetic eyes were divided into two groups: one group were given topical nepafenac drops and another who were not given. Demographic details, diabetic retinopathy stage, preoperative optical coherence tomography (OCT), and postoperative day (POD) 7, day 28, and 3 months OCT were collected. Statistical analysis was done to compare the change in TMV between both the groups. STATISTICAL ANALYSIS USED: Student's t-test and Chi-squared/Fisher's exact test were employed to find statistically significant differences between the two groups using SPSS-22.0 software. RESULTS: In our study, the mean age in the group with nepafenac was 60.93 ± 5.86 years and 31 (77.5%) had moderate nonproliferative diabetic retinopathy (NPDR), and in the group without nepafenac, the mean age was 58.53 ± 7.41 years and 30 (75%) had moderate NPDR. Majority of the individuals in the study group were known diabetic for 2-5 years. Change in TMV at POD 3 months among two groups was not statistically significant; P = 0.758 (P < 0.05-significant). CONCLUSIONS: Our study concluded that topical-NSAIDs played no role in postoperative period following cataract surgery with respect to change in TMV in diabetic eyes. Thus, prophylactic usage of topical-NSAIDs can be a burden on patient as it has no role in prevention of pseudophakic-CME in those with the duration of diabetes mellitus <5 years and with mild-to-moderate NPDR.

Complications of pupil expansion devices: a large real-world study.

Purpose: To assess the risk for uveitis, pseudophakic cystoid macular edema (PCME), and posterior capsular opacification (PCO) associated with the use of pupil expansion devices in cataract surgery. Design: A retrospective comparative cohort study. Participants: Patients who underwent routine cataract surgery with and without pupil expansion devices at the Department of Ophthalmology, Bristol Eye Hospital, UK, between January 2008 and December 2017. Methods: This study included 39,460 eyes operated without a pupil expansion device and 699 eyes operated with the device. Odds ratios for uveitis and PCME when using a pupil expansion device were calculated using univariate and multivariate regression analysis, having age, gender, diabetes, pseudoexfoliation, and pupil expansion device as independent variables. Multivariate Cox regression controlling for age and gender was used to estimate hazard ratios (HR) for Nd : YAG laser capsulotomies. Results: Postoperative uveitis and PCME were reported in 3.9% and 2.7% of the eyes operated with a pupil expansion device compared to 2.3% and 1.3% operated without the device (p=0.005 and p=0.002, respectively). In univariate regression analysis, eyes with pupil expansion devices showed a higher risk of postoperative uveitis or PMCE after cataract surgery (OR 1.88, 95%CI 1.39-2.55, p<0.001). In multivariate regression analysis, the risk for PMCE was greater among diabetic patients and in eyes with a pupil expansion device than in those without (OR 1.50, 95%CI 1.24-1.83, P<0.001; OR 1.90, 95%CI 1.16-3.11, P=0.01). In Cox regression analysis adjusted for the patient's age and gender, the use of a pupil expansion device was associated with higher Nd : YAG laser capsulotomy rates (HR 1.316, 95%CI 1.011-1.714, P=0.041). Conclusion: In our large cohort study, the use of pupil expansion devices in cataract surgery was associated with an increased risk of major postoperative complications. Effective anti-inflammatory treatment and follow-up are warranted in eyes operated with a pupil expansion device.

Prevalence of Cystoid Macular Edema After Cataract Surgery in Eyes with Previous Macular Surgery.

OBJECTIVE: To determine the prevalence and risk factors for cystoid macular edema (CME) after cataract surgery in eyes that have previously undergone macular surgery. STUDY DESIGN AND METHODS: Retrospective consecutive interventional case series. Patient medical records and Spectral Domain Optical Coherence Tomography (SD-OCT) were reviewed for eyes that underwent vitrectomy for full thickness macular hole (FTMH), lamellar macular hole (LMH) or epiretinal membrane (ERM) and subsequent cataract surgery at a large private retina practice between 2016 and 2018. RESULTS: Around 9.1% of eyes (22/243) developed CME post cataract surgery. The mean time from macular surgery to cataract surgery was 273 days (range: 87-797) in eyes with CME and 289 days (range: 22-897) in eyes without CME (p = 0.67). There was no difference in final visual acuity between eyes with CME (20/40, logMAR 0.312) and without CME (20/30, logMAR 0.206) (p = 0.101). Compared with patients with FTMH or LMH, patients with epiretinal membrane were more likely to develop post cataract CME (OR = 2.97, p = 0.031, Chi square test). CONCLUSION: In eyes with history of macular surgery, the prevalence of post cataract surgery CME was around 9.1%. The development of CME is not dependent on timing of cataract surgery but is more common in eyes with history of epiretinal membrane.

A manually made needle for treating Pseudophakic cystoid macular edema by injecting triamcinolone acetonide in the suprachoroidal space: A case report.

PURPOSE: This case was conducted to report the effectiveness and security of a manually made needle to inject triamcinolone acetonide in the suprachoroidal space (SCS) in a 52-year-old female with pseudophakic cystoid macular edema (PCME) in the challenging socio-economical situations in Syria. METHODS: This case report is an interventional case of a 52-year-old female presented with a four-week history of reduced vision secondary to Pseudophakic cystoid macular edema (PCME). The patient attended Marashi Eye Clinic Center for a clinical examination and followed up with Optical Coherence Tomography (OCT) at baseline. The patient was treated by one injection of triamcinolone acetonide and followed up within one week, 4 weeks, 8 weeks, 16 weeks, and 24 weeks in the suprachoroidal space (SCS) using a manually made needle with assessing the efficacy and potential ocular complications. RESULTS: The best-corrected visual acuity (BCVA) had improved significantly from baseline 20/60 to 20/30 at 24 weeks with a complete anatomical resolution of macular edema at 24 weeks from baseline. No ocular complications were noticed during the study period. CONCLUSIONS AND IMPORTANCE: Injecting triamcinolone acetonide in suprachoroidal space (SCS) using a manually made needle plays an essential role in treating Pseudophakic cystoid macular edema (PCME) without compromising security and efficiency.

Simultaneous existence of three intraocular lens inside one eye.

The purpose of the study was to report an unusual case of recurrent pseudophakic cystoid macular edema (PCME) in an eye with three simultaneous intraocular lenses (IOLs) inside. A 57-year-old female with diabetes mellitus (DM) and a history of complicated cataract surgery was diagnosed with cystoid macular edema (CME). Upon examination, an anterior chamber intraocular lens (ACIOL) with vitreous strand in her right eye was noted. The fluorescence angiography revealed CME of the right eye and microaneurysms in both eyes. Pars plana vitrectomy was performed to release the vitreous prolapse and traction around the ACIOL. During the surgery, two sunken posterior chamber IOLs in the vitreous were incidentally found and removed. The vitreous traction strand around the inappropriately placed anterior chamber ACIOL was also released. It was rarely reported that two dislocated IOL and ACIOL simultaneously existed in the same eye. Chronic recurrent PCME in this patient was possibly associated with posteriorly dislocated IOL, DM, and vitreous traction.

Fluocinolone Acetonide 0.19 mg Implant in Patients with Cystoid Macular Edema Due To Irvine-Gass Syndrome.

BACKGROUND: Cystoid macular edema (CME) due to Irvine-Gass syndrome (IGS) is one of the common causes of painless visual impairment post-cataract extraction. The treatment of recurrent cases remains unstandardized. OBJECTIVE: To evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (0.2 µg/day; ILUVIEN®) in the off-label treatment of recurrent CME due to IGS. METHODS: Retrospective 36-month case series in the Ophthalmology Department of Centro Hospitalar Universitário do Porto, Portugal. Consecutive eyes of patients with recurrent cystoid macular edema due to Irvine-Gass syndrome who underwent a single intravitreal injection of fluocinolone acetonide intravitreal implant were included. Best-corrected visual acuity (logMAR), central macular thickness (µm) and safety (intraocular pressure, mmHg) at baseline and at 6, 12, 24 and 36 months post-administration of the fluocinolone acetonide intravitreal implant were recorded. RESULTS: Five eyes from three patients were included. The duration of cystoid macular edema was 67.8±25.9 months and all five eyes received more than 2 intravitreal injections of a corticosteroid (triamcinolone and/or dexamethasone implant) prior to fluocinolone acetonide intravitreal implantation. At baseline (median - interquartile range), best-corrected visual acuity was 0.3-0.3; central macular thickness was 492.0-38.0; and intraocular pressure was 16.0-0. By Month 36, best-corrected visual acuity was 0.4 -0.3; central macular thickness was reduced to 369.0-324.0 and intraocular pressure was 17.0-3.0. Four of five eyes had increased intraocular pressure and were managed with intraocular pressure-lowering eye drops. CONCLUSION: We report improved functional and anatomical outcomes after treatment with fluocinolone acetonide intravitreal implant, indicating its use as a therapeutic alternative in recurrent cases of cystoid macular edema due to Irvine-Gass syndrome. Additionally, in eyes with suboptimal response to intravitreal therapies, fluocinolone acetonide intravitreal implant may provide longer recurrence-free periods with reduced treatment burden.

Subthreshold micropulse yellow laser for the management of refractory cystoid macular edema consequent to complicated cataract surgery.

PURPOSE: To report the safety and efficacy of subthreshold micropulse yellow laser of 577 nm for a complex case of refractory pseudophakic cystoid macular edema. METHODS: A retrospective chart review of an interventional case report of three subthreshold micropulse yellow laser interventions for refractory pseudophakic cystoid macular edema. PATIENT: A 77-year-old healthy female underwent pseudoexfoliative cataract surgery complicated by posterior capsule rupture and sulcus intraocular lens implantation. After 3 months, she required a scleral fixation of the same lens, due to a lack of capsular support and decentration of the intraocular lens. One month later, she experienced a severe pseudophakic cystoid macular edema (foveal thickness of 399 µm and best-corrected visual acuity of 20/80 Snellen). The condition was refractory to conventional treatments prior to subthreshold micropulse yellow laser interventions, including non-steroidal anti-inflammatory eye drops, topical steroids, oral indomethacin and three sub-Tenon's triamcinolone injections, attempted over a 14-month period. RESULTS: Subthreshold micropulse yellow laser treatment was performed and immediate resolution was achieved and maintained for 2 months. Two cases of edema relapse were observed at 3 months from initial laser treatment and again at 4 months from the second laser treatment. Final patient's follow-up at 6 months from the third laser treatment evidenced the absence of edema, improved visual acuity (foveal thickness of 265 µm/best-corrected visual acuity of 20/30 Snellen) and the absence of complications. CONCLUSIONS: Subthreshold micropulse yellow laser seems to be a safe and effective treatment for short-term resolution of refractory pseudophakic cystoid macular edema after complicated cataract surgery and represents a useful alternative to expensive and invasive therapies. A trend towards a longer duration of edema resolution with every subthreshold micropulse yellow laser repetition was observed.

Current Management Options in Irvine-Gass Syndrome: A Systemized Review.

Irvine-Gass syndrome (IGS) remains one of the most common complications following uneventful cataract surgery. In most cases, macular edema (ME) in IGS is benign, self-limiting, and resolves spontaneously without visual impairment; however, persistent edema and refractory cases may occur and potentially deteriorate visual function. Despite the relatively high prevalence of IGS, no solid management guidelines exist. We searched the PUBMED database for randomized clinical trials (RCT) or case series of at least 10 cases published since 2000 evaluating different treatment strategies in patients with cystoid macular edema (CME). The search revealed 28 papers that fulfilled the inclusion criteria with only seven RCTs. The scarceness of material makes it impossible to formulate strong recommendations for the treatment of IGS. Clinical practice and theoretical background support topical non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line therapy. Invasive procedures, such as periocular steroids, intravitreal corticosteroids, and anti-vascular endothelial growth factor (anti-VEGF), are usually applied in prolonged or refractory cases. Results of novel applications of subthreshold micropulse laser (SML) are also promising and should be studied carefully in terms of the safety profile and cost effectiveness. Early initiation of invasive treatment for providing better functional results must be examined in further research.

Anti-inflammatory Medication of Cataract Surgery in Pseudoexfoliation Syndrome - NSAID Is Needed.

BACKGROUND: To optimize the anti-inflammatory treatment of cataract surgery in pseudoexfoliation syndrome (PXF) eyes. METHODS: A prospective randomized double-masked trial. Sixty eyes of 60 patients with PXF undergoing routine cataract surgery were randomized for potent topical postoperative anti-inflammatory medication either with prednisolone acetate (10mg/ml), nepafenac (1mg/ml) or their combination. Clinical outcome parameters were recorded at 28 days and 3 months. Recovery from surgery was recorded by a structured home questionnaire. RESULTS: Patient age and gender distribution, and all baseline ophthalmic and surgical parameters were comparable between the study groups. At 28 days, change in central subfield macular thickness was +11.4 ± 11.9 µm in prednisolone acetate group compared to +1.7 ± 16.8 µm in nepafenac (P = .017), and -0.3 ± 8.7 µm in combination therapy (P = .010) groups. At 3 months, the values were +11.8 ± 18.1 µm, +1.8 ± 17.5 µm (P = .055), and -1.3 ± 6.4 µm (P = .055), respectively. Pseudophakic cystoid macular edema (PCME) was reported in two eyes, both with prednisolone acetate monotherapy. After surgery, conjunctival injection lasted 6.5 ± 5.0 days and irritation of the eye 9.5 ± 8.5 days in prednisolone acetate group compared with nepafenac (2.6 ± 2.2 days; P = .037 and 4.3 ± 5.2 days; P = NS, respectively) and combination therapy (3.3 ± 1.9 days; P = NS and 3.0 ± 4.0 days; P = .025, respectively). CONCLUSIONS: Routine cataract surgery of PXF eyes with nonsteroidal anti-inflammatory drugs (NSAID) alone, or in combination with steroids resulted in faster recovery from surgery and avoidance of PCME compared to steroids alone. ABBREVIATIONS: BAB: blood-aqueous barrier; CDVA: corrected distance visual acuity; CDE: cumulative dissipated energy; CSMT: central subfield macular thickness; HRQoL: Health-related quality of life; IOP: intraocular pressure; logMAR: log of the minimum angle of resolution; NSAID: nonsteroidal anti-inflammatory drug; PCME: pseudophakic cystoid macular edema; PXF: pseudoexfoliation syndrome; OCT: optical coherence tomography; t.i.d.: three times a day; VA: visual acuity.

Development of "Predict ME," an online classifier to aid in differentiating diabetic macular edema from pseudophakic macular edema.

PURPOSE: Differentiating the underlying pathology of macular edema in patients with diabetic retinopathy following cataract surgery can be challenging. In 2015, Munk and colleagues trained and tested a machine learning classifier which uses optical coherence tomography variables in order to distinguish the underlying pathology of macular edema between diabetic macular edema and pseudophakic cystoid macular edema. It was able to accurately diagnose the underlying pathology in 90%-96% of cases. However, actually using the trained classifier required dedicated software and advanced technical skills which hindered its accessibility to most clinicians. Our aim was to package the classifier in an easy to use web-tool and validate the web-tool using a new cohort of patients. METHODS: We packaged the classifier in a web-tool intended for use on a personal computer or mobile phone. We first ensured that the results from the web-tool coincide exactly with the results from the original algorithm and then proceeded to test it using data of 14 patients. RESULTS: The etiology was accurately predicted in 12 out of 14 cases (86%). The cases with diabetic macular edema were accurately diagnosed in 7 out of 7 cases. Of the pseudophakic cystoid macular edema cases, 5 out of 6 were correctly interpreted and 1 case with a mixed etiology was interpreted as pseudophakic cystoid macular edema. Variable input was reported to be easy and took on average 7 ± 3 min. CONCLUSION: The web-tool implementation of the classifier seems to be a valuable tool to support research into this field.

Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: Mechanism, diagnosis, and management.

Cystoid macular edema (CME) is a form of macular retina thickening that is characterized by the appearance of cystic fluid-filled intraretinal spaces. It has classically been diagnosed upon investigation after a decrease in visual acuity; however, improvements in imaging technology make it possible to noninvasively detect CME even before a clinically significant decrease in central vision. Risk factors for the development of CME include diabetic retinopathy, retinal vein occlusion, uveitis, and cataract surgery. It has been proposed that eyes with elevated intraocular pressure after cataract surgery, including those treated with prostaglandin analog eye drops, may be at higher risk for the development of CME. We summarize the current knowledge of the molecular mechanisms underlying CME, the potential role of ocular surgery and topical glaucoma medication in increasing the risk of CME, the newly developed imaging methods for diagnosing CME, and the clinical management of CME.

Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac.

BACKGROUND: To evaluate the clinical course of pseudophakic cystoid macular edema (PCME) treated with topical non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: An analysis of the clinical course of PCME consisting of 536 eyes of 536 patients from five consecutive randomized clinical trials aimed at the optimization of anti-inflammatory medication in patients undergoing routine cataract surgery. PCME was classified as (i) grade 0a; no macular thickening, (ii) grade 0b; macular thickening (central subfield macular thickness (CSMT) increase of at least 10%) without signs of macular edema, (iii) grade I; subclinical PCME, (iv) grade II; acute PCME, (v) grade III; long-standing PCME. Eyes with PCME classification from grade I onwards were treated with nepafenac 1 mg/mL t.i.d. for two months. RESULTS: CSMT increase of at least 10% at any postoperative timepoint with cystoid changes-a criterion for PCME-was found in 19 of 536 eyes (total incidence 3.5%). Of these 19 eyes, 13 eyes (total incidence 2.4%) had clinically significant PCME. PCME was considered clinically significant when both of the following visual acuity criteria were fulfilled. At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals. Only one of the 19 eyes with criteria for PCME (total incidence 0.2%, incidence of PCME eyes 5.3%) showed no macular edema resolution within 2 months after topical nepafenac administration. Conclusions: PCME in most cases is self-limiting using topical nepafenac without any further need for intravitreal treatment.