Eyeworld

EW RESIDENTS 78 August 2017 by Steven Tucker, MD, John Allen, MD, Kathleen Petro, MD, John Wilgucki, MD, Zachary Balest, MD, Nikhil Anand, MD, James Lockwood, MD, Jonathan Katz, MD, John Morgan Micheletti, MD, Hannah Park, MD, Sahitya Reddy, MD, and Sandeep Walia C ataract surgery is the most frequently performed surgical procedure in the U.S. The number of cases is projected to rise as the number of people in the U.S. with cataracts is expected to increase from 24.4 million to 50 million by the year 2050. 1 With advances in both surgical techniques and tech- nology, 20/20 visual outcomes in uncomplicated cataract surgery have become achievable in most cases. Cystoid macular edema (CME) is an example of a complication caused by an inflammatory re- sponse that can affect postoperative visual acuity. The incidence of CME demonstrated in various studies ranges up to 2.35%, with a peak in cases occurring between 4 and 6 weeks postoperatively. 2 CME can be evaluated both clinically via slit lamp biomicroscopy and angio- graphically via either fluorescein an- giography or spectral domain optical coherence tomography (SD-OCT). OCT is a non-invasive imaging test that uses interferometry to generate a cross sectional view of the retina. It allows clinicians to identify and quantitate both clinical and subclin- ical CME. Much of the research on CME has associated the release of prosta- glandins with the development of the clinical disease process. There are many known risk factors for the development of CME ranging from other ocular pathology to medica- tion use. One controversial class of agents that may affect the develop- ment of CME is prostaglandin ana- logues (PGAs) such as latanoprost. Given the association of prostaglan- din release with the development of CME, it is a logical step to assume that PGAs could induce CME. As a result, many clinicians recommend discontinuing PGAs prior to cat- aract surgery. Demonstrating the controversy surrounding this topic, a questionnaire indicated that 60% of surgeons in the United Kingdom continue PGAs during the periopera- tive period while 40% stop PGAs. 3 Similar to the increase in inci- dence of cataract, the number of in- dividuals with glaucoma is expected to rapidly increase from 2.7 million individuals with the disease process in 2010 to 6.3 million in 2050. PGAs are commonly used first-line agents for lowering intraocular pressure in patients with glaucoma. Given the significant overlap between those with glaucoma and those with cataract, there is an importance in understanding the impact PGA use has on CME. Study review The study under review was a single-site, single-surgeon pro- spective study including 60 eyes of 48 patients undergoing routine phacoemulsification with IOL Review of "Incidence of pseudophakic cystoid macular edema and OCT-detectable changes in central macular thickness in patients receiving prostaglandin analogues in the perioperative period: a prospective observational study" Jeremy Jones, MD, assistant professor of ophthalmology and residency program director, Emory Eye Center, Atlanta Are glaucoma patients taking pros- taglandin analogues at greater risk of CME following cataract sur- gery? I asked the Emory residents to review this paper in the August issue of JCRS. —David F. Chang, MD, EyeWorld journal club editor continued on page 80 Emory Eye Center residents; front row: Kathleen Petro, MD, Steven Tucker, MD, Jeremy Jones, MD, and John Morgan Micheletti, MD; back row: John Wilgucki, MD, Zachary Balest, MD, and James Lockwood, MD Source: Emory Eye Center

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