Retinal complications of cataract surgery

Main retinal complications of cataract extraction are retinal detachment and cystoid macular edema. The incidence of retinal detachment after ex traction is 1 %, and may increase after Nd: YAG laser capsulotomy to 4 %. Cystoid macular edema in aphakic or pseudophakic patients is unusually transient, with a decrease of visual acuity in about 3 % of cases; a long lasting cystoid macular edema with prolonged visual deficiency is described in only 1 % of cases. The incidence of photic macular injuries is estimated at between 7 and 28 % of cases; most photoretinal injuries are asymptomatic or minimally symptomatic because of their extrafoveolar location. Finally, the visual prognosis after cataract surgery is poor in diabetic patients, because of the frequency of cystoid macular edema and progression of diabetic retinopathy.     

Cystoid macular edema after cataract surgery with intraocular vancomycin.

OBJECTIVE: To determine whether the use of supplemental prophylactic vancomycin in the irrigating solution during extracapsular lens extraction is associated with increased incidence of cystoid macular edema. DESIGN: Prospective, randomized, double-masked clinical study. PARTICIPANTS: Consecutive series of 118 patients 60 years of age or older undergoing cataract surgery. INTERVENTION: The study group received an irrigating balanced salt solution supplemented with vancomycin (10 microg/ml), and the control group received the salt solution only. Fluorescein angiography was performed 1 and 4 months after surgery. MAIN OUTCOME MEASURES: Evidence of angiographic and clinical cystoid macular edema, and visual acuity at 1 and 4 months after surgery. RESULTS: The rate of postoperative angiographic cystoid macular edema was significantly higher in the study patients than in the control group at 1 month (55% vs. 19%, P = 0.0006) and 4 months (26% vs. 4%, P = 0.0099). The rates of clinical macular edema were 23% and 7%, respectively, at 1 month (P = 0.011) and 20% versus 0% at 4 months (P = 0.006). Visual acuity of 20/30 or better was noted at 4 months after surgery in 76% of the study group compared to 95.5% of the control group. CONCLUSIONS: The role of preventive intracameral vancomycin during intraocular surgery should be reassessed in view of the associated increase in the incidence of angiographic cystoid macular edema.     

Biomicroscopic study of the vitreous in eyes with macular pucker after retinal detachment surgery

The posterior vitreous condition of 43 eyes with macular pucker following retinal detachment surgery was studied using the El Bayadi-Kajiura preset lens mounted on a slit lamp. The posterior vitreous was found to be attached in one eye (2%), completely detached in 29 eyes (68%), and partially detached with residual vitreoretinal adhesion to the macular area in 13 eyes (30%). Macular pucker with partial posterior vitreous detachment was significantly more frequent (P less than .05) in eyes with refractive errors of -4 diopters or less. That condition was also accompanied by a higher incidence of dye leakage in the macular area by fluorescein angiography, a shorter time lapse between retinal detachment surgery and development of macular pucker, and a worse visual outcome than was found in eyes with complete posterior vitreous detachment.     

Intraocular surgery in advanced glaucoma.

Loss of visual field subserving macular function has been found to be rare after intraocular surgery in advanced glaucoma. Abrupt changes in refractive error, lens opacity, and suppression must be carefully excluded before macular fixation is deemed lost. Out of 69 intraocular procedures (46 drainage operations, 13 cataract extractons) two patients lost central visual field subserving macular fixation possibly as a result of surgery. There is an increased incidence of postoperative maculopathy in late glaucoma. Three drainage operations out of 46 and four cataract extractions out of 13 had this complication. Altogether 30% of drainage procedures induced deterioration of visual acuity of lenticular origin to a level normally requiring cataract extraction. Trabeculectomy was found to be less likely to cause this sequela than the Scheie procedure at the 6 month postoperative stage. However, 77% of patients with advanced glaucoma and cataract obtained a satisfactory improvement in visual status after cataract extraction.     

Evaluation of changes of macular thickness in diabetic retinopathy after cataract surgery

Purpose

To assess the macular thickness changes after cataract surgery in diabetic patients using optical coherence tomography (OCT).

Methods

We retrospectively reviewed the records of 104 diabetic patients who underwent cataract surgery. We examined the changes of macular thickness using OCT before cataract surgery and 1 week, 1-, 2- and 6-months after surgery. The central subfield mean thickness (CSMT) was used to evaluate macular edema which was defined as an increase of CSMT (ΔCSMT) > 30% from the baseline. The association between prior laser treatment or severity of diabetic retinopathy and macular thickness were also analyzed.

Results

Macular edema occurred in 19 eyes (18%) from the diabetic group and 63% of macular edema developed at 1 month after surgery. Thirteen (68%) out of 19 eyes with macular edema showed the resolution of macular edema by 6 months after surgery without treatment. ΔCSMT of eyes without a history of laser treatment was statistically greater compared to eyes with a history of laser treatment in at 1- and 2-months after surgery, but was not different than eyes who had laser treatment at 6-months after surgery. The severity of diabetic retinopathy was not significantly correlated to macular edema, but there was statistical difference when patients who had a history of prior laser treatment were excluded.

Conclusions

The incidence of macular edema after cataract surgery in diabetic patients was 18%. Its peak incidence was at 1 month post surgery and it resolved spontaneously in 68% of patients by 6 months post surgery. Prior laser treatment might prevent postoperative macular edema until 2 months after cataract surgery in diabetic patients. However, macular edema did not affect the severity of diabetic retinopathy.     

A controlled study of vitrectomy for diabetic macular edema

PURPOSE: To compare eyes that underwent surgery with untreated fellow eyes to assess the efficacy of vitrectomy for diabetic macular edema. METHODS: In a nonrandomized clinical trial, seven adult patients with mean age of 53 years (range 42 to 64) and the same degree and duration of diabetic macular edema in both eyes were followed up for more than 5 months after unilateral vitrectomy. The treated eye was selected at random, but if visual disparity between the both eyes was more than 3 lines, we operated on the worse side. We compared the preoperative and postoperative foveal thicknesses (the distance between the inner retinal surface and retinal pigment epithelium) and the best-corrected visual acuity by a certified examiner with those of the untreated fellow eye. RESULTS: In the seven eyes that underwent surgery, the foveal thickness decreased by an average of 622 to 269 microm (P =.027, Wilcoxon signed-rank test). In the fellow eyes, the average decrease in foveal thickness was from 617 to 546 microm (P =.176, Wilcoxon signed-rank test). The best-corrected postoperative visual acuity in the eyes that underwent surgery improved more than 2 lines in four eyes (57%) and remained the same in three eyes (43%). In the fellow eyes, it improved more than 2 lines in one eye (14%), remained the same in three eyes (43%), and decreased more than 2 lines in three eyes (43%). CONCLUSION: In eyes with diabetic macular edema that underwent surgery, the foveal thickness significantly decreased after vitrectomy. Vitrectomy may be effective for treating diabetic macular edema.     

1g/L溴芬酸钠水合物滴眼液对白内障术后黄斑水肿的预防

目的：探讨1g/L溴芬酸钠水合物滴眼液对白内障超声乳化术后黄斑水肿的预防作用。方法：采用前瞻性临床随机对照试验。将行白内障超声乳化吸除联合人工晶状体植入术的年龄相关性白内障患者随机分为两组,每组118眼。试验组：术前2 d和术后4 wk应用1 g/L溴芬酸钠水合物滴眼液,联合术后2 wk应用妥布霉素地塞米松滴眼液;对照组：术后2 wk应用妥布霉素地塞米松滴眼液。分别在术前2d内,术后1d、1、4、12 wk测定黄斑中心亚区域平均厚度( CSMT ),并计算术后黄斑水肿发生率。结果：术前、术后1d,1、12wk 试验组与对照组 CSMT 比较,差异均无统计学意义(P>0.05);术后4wk 试验组CSMT 为251.57±6.814μm,低于对照组的262.41±7.295μm,差异有统计学意义(P<0.05);术后1d,1、4、12wk试验组黄斑水肿发生率分别为0、0、0.9%、0.9%,对照组分别为0、0.9%、8.5%、1.7%,两组黄斑水肿发生率比较,仅术后4wk差异有统计学意义(P<0.05)。结论：白内障超声乳化术前和术后应用1g/L溴芬酸钠水合物滴眼液,能有效预防术后黄斑中心亚区域增厚,减少黄斑水肿发生率。     

孔源性视网膜脱离术后黄斑裂孔形成的原因分析

目的 探讨孔源性视网膜脱离术后黄斑裂孔形成的原因.方法 回顾性分析2017年10月至2019年12月武汉大学人民医院东院眼科所有孔源性视网膜脱离手术患者的临床资料,筛选术后发生黄斑裂孔的患者,结合光学相干断层扫描(OCT)检查结果分析黄斑裂孔形成的原因.结果 本研究共纳入孔源性视网膜脱离手术患者409例(423眼),其...     

Inzidenz und Ausprägung von postoperativem Makulaödem nach Makulaforamenoperation mit und ohne kombinierte Kataraktoperation

PURPOSE. In the majority of patients with full-thickness macular hole, closure can be achieved with vitreoretinal surgery techniques. However, postoperative function is variable and the prognostic determinants for visual acuity are incompletely understood. We evaluated the incidence and extent of macular edema after macular foramen surgery with and without combined cataract-surgery. METHODS. Between October 1997 and March 2001 macular foramen surgery was performed in 125 eyes from 116 patients. Fluorescein angiograms with sufficient quality were obtained from 59 eyes using a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph, HRA, Heidelberg Engineering, Heidelberg) and were evaluated by two independent observers. RESULTS. Angiographic macular edema was noted on average 4.2 months after the operation in 47 out of 59 (79.7%) eyes. The incidence of macular edema was 87% in eyes after a combined cataract operation compared to 66.7 % in eyes with no simultaneous operation ( p=0.735). Mean postoperative visual acuity was 0.4 (min 0.1-max 1.2) with no significant difference between eyes with (4.1 lines) and without macular edema (3.5 lines) with regard to visual improvement from baseline. CONCLUSIONS. The results indicate a high incidence of macular edema in eyes after macular hole surgery with subsequent anatomical success. Apparently, the presence of macular edema is not associated with short term visual impairment. Furthermore it seems that a combined cataract operation compared to a consecutive procedure is not associated with disadvantages regarding the functional outcome.     

超声乳化术对白内障合并特发性黄斑前膜患者黄斑形态的影响

目的:分析白内障合并特发性黄斑前膜(IERM)患者行超声乳化术前后黄斑前膜(ERM)分级、黄斑区形态及最佳矫正视力(BCVA,LogMAR)情况。方法:回顾性病例研究。纳入2016-03/2019-05于我院接受超声乳化术的白内障合并IERM患者51例54眼,分析术前和术后1mo ERM分级、黄斑囊样水肿(CME)、椭圆体带中断和神经上皮层脱离(NSD)的发生及BCVA情况。结果:本组患者术前5眼(9%)ERM 1级,23眼(43%)ERM 2级,21眼(39%)ERM 3级,5眼(9%)ERM 4级;术后1mo ERM分级保持稳定。术后1mo BCVA(0.47±0.17)与术前(0.45±0.16)相比无显著变化(P>0.05),但CME、椭圆体带中断及NSD发生率均较术前显著升高(P<0.05)。结论:超声乳化术并没有显著加快ERM进展和影响BCVA,但显著增加了视网膜黄斑中心凹的炎症反应,故对合并IERM的患者进行白内障手术后需密切随访,如果黄斑区改变影响了BCVA,应尽早行玻璃体切割手术。     

Cystoid macular edema in the first week after cataract extraction.

Fluorescein angiography was safely performed in 100 consecutive cases of cataract extraction during the first postoperative week. Seventy-five percent of the 100 eyes had good quality fluorescein angiograms. Four eyes demonstrated cystoid macular edema. Therefore, the incidence of cystoid macular edema in the first week after cataract surgery was low when compared to the reported incidence (40%) four to six weeks postoperatively.     

Macular edema after corneal graft: a prospective study by optical coherence tomography

PURPOSE: Vision recovery after corneal graft is sometimes limited by the occurrence of macular edema. The aim of this prospective study of 62 keratoplasty patients was to assess the incidence of macular edema by using optical coherence tomography (OCT 3; Stratus, Carl Zeiss Meditec, Dublin, CA) and to identify factors associated with edema. METHODS: Sixty-two patients who were all operated on by the same surgeon were examined by OCT 3, 1 and 3 months after corneal graft. RESULTS: The incidence of macular edema after keratoplasty was 9.6%. The surgical technique (penetrating vs lamellar keratoplasty) had no influence on the occurrence of edema (P > 0.05), but combined surgery significantly increased the risk of developing an edema (P < 0.05). CONCLUSION: Macular edema after keratoplasty seemed to be less frequent than expected (9.6%) and associated mainly with combined surgery.     

The natural history of macular edema after cataract surgery in diabetes

OBJECTIVE: To determine the natural history of macular edema after cataract surgery in diabetes to provide a rational basis for laser therapy. DESIGN: Prospective clinical and angiographic trial. PARTICIPANTS: Thirty-two patients with diabetes undergoing cataract surgery. INTERVENTION: Phacoemulsification surgery with intraoperative fluorescein angiography, and postoperative clinical and angiographic assessment without macular laser therapy for 1 year after surgery. MAIN OUTCOME MEASURES: Clinically significant macular edema, postoperative macular and optic disc hyperfluorescence relative to the intraoperative angiogram, and logarithm of the minimum angle of resolution (LogMAR) visual acuity. RESULTS: In the first postoperative year, macular fluorescence remained at its intraoperative level in 2 (6%) of 32 eyes and increased in 30 (94%) of 32 eyes, returning to its intraoperative level within 1 year of surgery in 13 (43%) of 30 eyes. Optic disc fluorescence remained at its intraoperative level in 2 (6%) of 32 eyes, was not graded in 3 (9%) of 32 eyes, and increased in 27 (84%) of 32 eyes, returning to its intraoperative level within 1 year of surgery in 19 (70%) of 27 eyes. Clinically significant macular edema was identified in the first postoperative year in 18 (56%) of 32 eyes, being present at the time of surgery in 5 eyes and arising de novo within 1 year of surgery in 13 eyes. It resolved spontaneously within 1 year of surgery in 0 of 5 eyes in which it had been present at the time of surgery and in 9 (69%) of 13 eyes in which it arose in the first 6 months after surgery (P = 0.05). Angiographic and clinical resolutions of macular edema were less likely in eyes with more severe retinopathy at the time of surgery (P = 0.03, 0.005). One-year LogMAR acuity of 0.3 or less (> or = 20/40) was achieved in 27 (84%) of 32 eyes. Clinically significant macular edema at the time of surgery was associated with poorer 1-year visual acuity in multivariate analysis (P = 0.005, r2 = 0.5). CONCLUSIONS: Clinically significant macular edema present in diabetic eyes at the time of cataract surgery is unlikely to resolve spontaneously, but clinically significant macular edema arising after surgery commonly resolves, particularly if retinopathy is mild. These findings have implications for the timing of cataract surgery in diabetes and postoperative macular laser therapy. Ophthalmology 1999;106:663-668     

Incidence of Reopening and Variables That Influence Reopening After Macular Hole Surgery

Purpose: To evaluate the incidence and variables of reopening of macular holes after macular hole surgery.Methods: Our study included 467 eyes in which macular holes were successfully closed after surgery. Surgical techniques consisted of conventional methods (358 eyes) and scalping methods (109 eyes) with retinal pigment scalping of the macular hole basis added in such cases: reoperation, hole size (more than 0.4 disc diameter), duration of symptoms (more than 2 years). Long term incidence of reopening was predicted by life table method. After we compared reopened cases with non-reopened cases, the variables of gender, stage, biocular occurrence, age, duration of symptoms, hole size, preoperative visual acuity, refraction axial length ratio, and intraoperative retinal tears were used for the multiple regression.Results: Reopening was found in 20 eyes (5.6%) treated by conventional methods and in 10 eyes (9.2%) treated by scalping methods. Survival ratio was 87% for the conventional methods in 6 years and 79% for the scalping methods in 5 years. The variables influencing reopening were as follows: conventional methods: gender (r = 0.065, P =.19), biocular occurrence (r = 0.12, P =.026), and refraction axial length ratio (r = -0.11, P =.045); scalping methods: hole size (r = 0.14, P =.25).Conclusions: Incidence of reopening in scalping methods was high. The variables that influenced reopening after macular hole surgery were biocular occurrence and refraction axial length ratio in conventional methods. The shape of the eye may be related to reopening.     

Peripheral visual field defects after macular hole surgery: a complication with decreasing incidence

AIM: To prospectively evaluate peripheral visual fields after vitrectomy for idiopathic macular holes. METHODS: Goldmann perimetry was performed in 105 patients before, as well as 6 weeks and 12 months after macular hole surgery. RESULTS: Only one patient (< 1%) with a stage III macular hole developed an asymptomatic postoperative visual field defect. The scotoma was wedge-shaped, peripherally located in the temporal quadrant, and remained unchanged during the following 12 months. CONCLUSION: Peripheral visual field defects after macular hole surgery can be a complication of very low incidence. A rather low pressure set during air-fluid exchange as well as special aspects of the surgical technique may be responsible for this low incidence of peripheral visual field defects.     

两种非甾体抗炎药对白内障术后黄斑水肿影响的对比研究

目的比较0.1%溴芬酸钠水合物滴眼液和普拉洛芬滴眼液对白内障超声乳化术后黄斑水肿的影响。方法采用前瞻性临床随机对照试验。将行白内障超声乳化吸除联合人工晶状体植入术的年龄相关性白内障患者随机分为两组,每组118只眼。A组:术前2 d和术后4周应用0.1%溴芬酸钠水合物滴眼液,联合术后2周应用妥布霉素地塞米松滴眼液;B组:术前2 d和术后4周应用普拉洛芬滴眼液,联合术后2周应用妥布霉素地塞米松滴眼液。分别在术前2 d内,术后1 d、1、4、12周测定黄斑中心亚区域平均厚度(CSMT),并计算术后黄斑水肿发生率。结果术前、术后1 d、1周、12周A组与B组CSMT比较,差异均无统计学意义(P>0.05);术后4周A组CSMT为(251.57±6.814)μm,低于B组的(254.40±12.004)μm,差异有统计学意义(P<0.05);术后1 d、1、4、12个月试验组黄斑水肿发生率分别为0、0、0.85%、0.85%,对照组分别为0、0.85%、1.69%、1.69%,术后各时间点两组黄斑水肿发生率比较,差异均无统计学意义(P>0.05)。结论白内障超声乳化术前和术后应用0.1%溴芬酸钠水合物滴眼液或普拉洛芬滴眼液,术后黄斑水肿发生率均较低,前者比后者可能会更大程度地抑制术后黄斑中心亚区域增厚。     

Vitrectomy in the treatment of epimacular membranes (macular pucker)

The formation of contractile membranes on the inner retinal surface of the macula (macular pucker, epiretinal gliosis) has an increased incidence with age. They also occur in vascular or inflammatory disorders of the posterior segment, after blunt injuries, retinal detachment surgery, and coagulation therapy. Surgical removal of epiretinal membranes in the macula by vitrectomy is performed since 1978. Our analysis of 78 consecutive patients with a postoperative follow-up from 6 to 36 months showed good anatomical and functional results. Visual impairment caused by metamorphopsia decreased in all patients. Visual acuity improved two lines or more in 55 cases (70.5%). 22 (28.2%) were unchanged (including improvement of one line), and one eye (1.3%) became worse. Functional results were significantly better in eyes with macular pucker of less than 6 months duration and with thin, transparent membranes. The age of patients is not likely to play a significant role for functional outcome. Complications were cataracts in 10, retinal defects or detachments in 5 patients, and recurrence of the epiretinal membrane in 2 cases.     

视网膜脱离复位后视功能研究

目的 研究视网膜脱离（ＲＤ）术后视功能的恢复及其影响因素。方法 选择孔源性ＲＤ痊愈病例２３３例（２３８眼）,采用Ｘ＾２检验进行统计分析。结果 术前３６．７％患者视力≥０．１,而术后为８１．４％（Ｐ〈０．０１）;术前黄斑不脱离和脱离１周内的患者术后视力１００．０％≥０．３,脱离１周后只有２７．１％的患者有相应的视力;术前视力与术后视力明显相关（r＝０．５１７,Ｐ〈０．０１）。结论 ＲＤ术后视力得到不     

Comparison of 23‐gauge sutureless sclerotomy architecture and clinical outcomes in macular and non‐macular surgery using spectral‐domain optical coherence tomography

Purpose: To compare the 23‐gauge (23‐G) sutureless vitrectomy incision architecture in macular and non‐macular surgery, using anterior segment spectral‐domain optical coherence tomography (SD‐OCT), and to evaluated its influence on clinical outcomes. Methods: A prospective, observational case series of 43 patients who underwent primary transconjunctival 23‐G pars plana vitrectomy (PPV) for macular and non‐macular diseases. All sclerotomy wounds were imaged 1 day after surgery using the anterior segment module of SD‐OCT (OCT Spectralis; Heidelberg Engineering, Heidelberg, Germany). Sclerotomy architecture, including good wound apposition, presence of gaping and misalignment of the roof and floor of the incisions were evaluated. Preoperative, intraoperative and postoperative medical record data were also prospectively collected. Results: Incision gaping and misalignment of the roof and floor occurred more frequently in the superotemporal and superonasal quadrants than in the inferotemporal quadrant (p < 0.05) and was more frequent in the non‐macular group than in the macular group (p < 0.05). The incidence of incision gaping increased significantly as the incision angle increased. In the macular group, the mean postoperative intraocular pressure (IOP) did not change from the preoperative value, whereas in the non‐macular group, the mean IOP decreased significantly from 15.09 ± 2.58 mmHg preoperatively to 12.18 ± 3.25 mmHg on the first postoperative day (p < 0.005). The mean IOP did not differ significantly between the two groups of surgery at 1 week, and at 1 month postoperatively. Conclusions: In 23‐G PPV, non‐macular surgery is associated with a significant postoperative IOP decrease in comparison with macular surgery, which could be explained by the most remodelled wound architecture.     

Prevalence of optical coherence tomography-diagnosed postoperative cystoid macular oedema in patients following uncomplicated phaco-emulsification cataract surgery

Background: Postoperative cystoid macular oedema is a complication of uneventful cataract surgery. Whereas improved surgical techniques have decreased the incidence of cystoid macular oedema, it remains a cause of unfavourable visual outcome following surgery. Fundus fluorescein angiography has been the ‘gold standard’ for diagnosing subclinical cystoid macular oedema; however, non‐invasive cross‐sectional imaging of the retina with optical coherence tomography may be equally effective at detecting the condition and offers the ability to quantify and repeat results over time. Design: Prospective pre–post case series of patients undergoing routine phaco‐emulsification surgery. Participants: Eighty consecutive patients (100 eyes) with cataracts and an age range of 40 to 90 years (mean 76.18). Methods: Macular thickness of participants was determined using time‐domain optical coherence tomography preoperatively and after surgery at 1 day, 1 week, 4 weeks and 6 months. Optical coherence tomography was used to diagnose postoperative cystoid macular oedema. Main Outcome Measures: Presence of cysts at the macula, identified by optical coherence tomography, in addition to foveal and macular thickness (µm). Results: Cystoid macular oedema was present in 5% of eyes. Macular thickness increased after surgery and central foveal thickness increased by almost 7% but returned to preoperative levels after 6 months. Findings also indicate that patients who developed postoperative cystoid macular oedema had significantly thicker central foveal thickness of approximately 5% compared with those that did not. Conclusions: Optical coherence tomography is a useful, non‐invasive diagnostic tool in determining subclinical cystoid macular oedema in uncomplicated cataract surgery patients and detects the presence of retinal thickening and intra‐retinal cysts very soon after surgery, thereby facilitating earlier diagnosis and treatment of postoperative cystoid macular oedema.