Managing cystoid macular edema after cataract surgery

Cystoid macular edema (CME) is a common problem after cataract extraction. It can occur after uncomplicated surgery in patients with otherwise healthy eyes, after complicated surgery, or after surgery in patients with ocular diseases such as uveitis or diabetic retinopathy. Usually vision loss from cystoid macular edema is temporary and responds to treatment with topical anti-inflammatory medications. However, some cases respond poorly to conservative treatment and may develop permanent visual loss. A review of the medical literature was performed for all articles published in English between August 1, 2001 and July 31, 2002 on the topic of cystoid macular edema after cataract surgery. The authors selected nine articles that were most relevant to the practicing ophthalmologist for inclusion in this review. Topics of interest included vitreous loss, retained lens fragments, diabetes, uveitis, retinitis pigmentosa, ocular hypotensive lipids, internal limiting membrane peeling, and intravitreal triamcinolone injection.     

白内障术后黄斑囊样水肿的研究进展

黄斑水肿作为白内障术后的并发症,人们对其作了大量的临床研究.本文对近年来的相关报道作一综述,主要介绍了白内障术后黄斑水肿的发病机制,与各手术方式及植入晶状体的关系,临床特征,检查手段及治疗方法等多个方面.结论：白内障术后黄斑囊样水肿可随手术技术进步而减少发病率,但仍应重视对黄斑水肿的早期发现和及时干预.     

Evaluation of costs for cystoid macular edema among patients after cataract surgery

PURPOSE: Little is known about the costs of cystoid macular edema (CME), an important complication associated with cataract surgery. The purpose of this analysis was to estimate the cost of treatment for CME in the United States. METHODS: Data were analyzed from the 1997 through 2001 Medicare 5% Beneficiary Encrypted Files. Beneficiaries who underwent cataract surgery were identified and stratified by diagnosis of CME (cases) or no diagnosis of CME (controls) within 1 year after surgery. Claims and reimbursements for ophthalmic care were identified. Subgroup analyses explored CME costs among beneficiaries with diabetes versus those without diabetes. RESULTS: Of 139,759 beneficiaries with cataract surgery, 1.95% (2,720) were diagnosed with CME. Annual total ophthalmic claims were 41% ($3,298) higher for cases than for controls; payments were 47% ($1,092) higher (both P < 0.0001). Approximately 16% (23,122) of cataract patients had diabetes. The rate of CME diagnosis was significantly higher for diabetics than for nondiabetics (3.05% vs. 1.73%, respectively). Differences in claims and payments between cases and controls were similar for diabetic and nondiabetic subgroups. CONCLUSION: CME is associated with substantial costs. Therapies that prevent or decrease CME severity are likely to result in cost savings, particularly among diabetic beneficiaries. Further analyses should explore the relationship of comorbidities to costs among CME patients.     

玻璃体腔注射曲安奈德治疗白内障术后黄斑囊样水肿疗效观察

目的:观察玻璃体腔注射曲安奈德(triamcinoloneacetonide,TA)治疗白内障术后黄斑囊样水肿(cystoid macular ede-ma,CME)的疗效。方法:对21例22眼经间接检眼镜、荧光素眼底血管造影(FFA)以及光学相干断层扫描(OCT)检查确诊的CME患者行TA玻璃体腔注射,治疗后随访0.5a,对比分析术前术后不同时期的视力、眼底、FFA表现,观察OCT显示黄斑水肿高度。结果:术前视力平均0.25±0.23,术后3mo平均0.58±0.27,差异有显著性(P<0.01);经OCT随访检查,术后所有病例患眼黄斑中心凹厚度均有下降,术前平均为(482.37±102.54)μm,术后3mo平均为(205.46±113.35)μm,差异有显著性(P<0.01)。结论:玻璃体腔注射TA是一种安全有效的治疗白内障术后黄斑囊样水肿的方法。     

玻璃体腔注射改良低剂量曲安奈德治疗白内障术后黄斑囊样水肿

目的：探讨玻璃体腔注射改良低剂量曲安奈德(TA)治疗白内障术后黄斑囊样水肿(PCME)的疗效。

方法：回顾性分析。选取2015-01/2018-12于我院就诊的典型PCME 患者12例12眼行玻璃体腔注射改良低剂量TA。通过0.22μm的滤膜将TA 混悬液置换成眼内灌注液,取置换后的TA溶液2mg/0.05mL注射。观察注药后2wk,1、3、6mo的最佳矫正视力、黄斑中央厚度、眼压、局部和全身并发症。

结果：与注射前比较,所有患者注药后视力均显著提高; 黄斑中央厚度显著减低(P<0.05), 而眼压无明显升高(P>0.05),所有患者均未观察到眼部及全身并发症。

结论：玻璃体腔注射改良低剂量TA治疗PCME安全、有效,克服了以往导致眼压升高的副作用,价格低廉,能够使患者受益。但尚需大宗病例的临床随机对照研究和长期疗效的随访观察。     

糖尿病与白内障术后出现黄斑囊样水肿相关性的临床分析

目的:研究糖尿病因素对于白内障术后出现黄斑囊样水肿的影响.方法:行白内障超声乳化加后房型人工晶状体植入术患者共182眼,其中糖尿病者102眼,无糖尿病者80眼.术后随访6mo,比较两组黄斑囊样水肿发生率.结果:有糖尿病者并发黄斑囊样水肿发病率为14.7%,无糖尿病者发病率为3.8%.结论:糖尿病因素与白内障术后出现黄斑囊样水肿存在直接相关性.     

Prevention of cystoid macular edema following cataract extraction using local indomethacin application

In a randomized, controlled study drops of 1% aqueous solution of indomethacin were compared to Placebo to assess efficacy in the prevention of cystoid macular edema. The study involved 124 patients who had undergone intracapsular cataract extraction and 40 patients with implanted lenses. The study parameters--visual acuity, biomicroscopy observations of the macula and fluorescein angiography--were assessed for three months postoperatively. The long-term course was reviewed by regular outpatient follow-up visits or by questionnaires completed by the patients' personal ophthalmologists. Fluorescein angiography could only be carried out in 13 of the 40 patients who had intraocular lenses. The relatively high incidence of secondary cataract or pupillary synechiae made technically perfect exposures difficult. In 73 patients with intracapsular extraction, fluorescein angiography showed a distinct diminution in the incidence of edema in the indomethacin group at all three observation periods (3, 6 and 12 weeks postoperatively). The difference compared with placebo was significant at weeks 6 and 12. Ophthalmoscopically visible macular changes were rare. No evidence of edema was noted in any of the 51 patients who could not have fluorescein angiography for one reason or another. The visual acuity of patients who received indomethacin was not significantly different from that of those who received placebo. Furthermore, and this is important for the patients, in the group with proven edema no conclusion could be made about the effect of therapy on the severity and persistence of visual impairment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prophylaxis of cystoid macular edema after cataract surgery. Observation of an application of Chibro-Amuno

Report on the safety and efficacy of the prostaglandin synthesis inhibitor Chibro-Amuno 3 for the prevention of cystoid macular edema in 1,263 eyes operated on for cataracts by 70 different surgeons. The patients received the preparation from the day before the operation up to 12 weeks after. The number of women who underwent surgery was nearly twice as high as that of men. There was a frequency peak in age between 75 and 84 years. In 88.5% of all patients, removal of the lens was followed by implantation of an artificial lens, most commonly by a posterior-chamber lens. Extracapsular extraction was performed on nearly 70% of the eyes. Following intracapsular extraction, no artificial lens was implanted in only 13% of the cases. Complications occurred most frequently after phacoemulsification. Cystoid macular edema was found in only 17 patients (1.34%), and a related loss of vision occurred in 2 eyes. Preoperative risk factors appear to have played a role in the development of cystoid macular edema. We observed that it is more likely to develop after intracapsular than after extracapsular extraction. Furthermore, the risk increases with increasing surgery time, and a correlation exists between operation-related complications and the development of Irvine-Gass syndrome. Side effects were observed in 10% of the cases, most of them conjunctival complaints. Corneal damage attributed to Chibro-Amuno 3 healed without complications. Overall, the safety of the preparation is judged to be good.     

Corneal melting after use of nepafenac in a patient with chronic cystoid macular edema after cataract surgery

This report describes a patient who developed a corneal melt after the use of nepafenac, a nonsteroidal antiinflammatory drug. An 82-year-old woman with chronic cystoid macular edema after cataract extraction and intraocular lens implantation in the left eye, which was clinically controlled with a topical nonsteroidal antiinflammatory drug, was initially treated with diclofenac sodium 0.1% before being treated with nepafenac 0.1%. After 5 months of nepafenac use, the patient complained of pain, a foreign body sensation, and decreased vision in her left eye. The left eye showed a peripheral corneal ulcer with no stromal cell infiltration. The corneal ulcer was scraped and cultured to show epithelial cells and neutrophils with no growth of microorganisms. The nepafenac was discontinued, and a topical antibiotic and lubrication were used. After 2 months, the patient's visual acuity improved, and she had an intact epithelium and stable corneal thinning. To the authors' knowledge, this is the first case report of a corneal melt after the prolonged use of nepafenac to treat cystoid macular edema.