Eyeworld

EW RESIDENTS 80 August 2017 for the cumulative dissipated energy used for each surgery, a known risk factor for the development of CME. 4 The results do largely coincide with other retrospective studies, although these studies had different parame- ters and inclusion criteria, making comparisons difficult. The retrospec- tive study by Chu et al. included 81,984 eyes and showed an inci- dence of CME at 1.17% in patients without risk factors as well as no in- crease in risk with PGA use. 2 Ching et al. included 131 patients with a CME rate of 3.05%, but this did in- clude 44 patients with diabetes and eight with posterior capsule breaks, making comparison difficult. 5 This study attempts to deter- mine whether PGA use in patients undergoing cataract surgery is associated with an increased risk of CME. As mentioned, the widespread use of PGAs in glaucoma along with the increasing incidence of glauco- ma as well as cataracts is making this an integral question from the standpoint of patient safety and economics as the treatment of CME is substantial. Despite the lack of a control cohort, small sample size, and lack of a control for cumulative dissipated energy used for each case, the study does provide evidence that PGAs may have no significant im- pact on clinical CME after cataract surgery. Further studies with larger numbers and a control are necessary to further understand this topic. EW References 1. National Eye Institute. Cataracts. Statistics and Data. Accessed June 25, 2017. 2. Chu CJ, et al. Risk factors and incidence of macular edema after cataract surgery: A database study of 81984 eyes. Ophthalmolo- gy. 2016;123:316–323. 3. Ahad MA, et al. Stopping prostaglandin analogues in uneventful cataract surgery. J Cataract Refract Surg. 2004;30:2644–5. 4. Anastasilakis K, et al. Macular edema after uncomplicated cataract surgery: a role for phacoemulsification energy and vitreoretinal interface status? Eur J Ophthal. 2015;25: 192–7. 5. Ching HY, et al. Cystoid macular oede- ma and changes in retinal thickness after phacoemulsification with optical coherence tomography. Eye (Lond). 2006;20:297–303. Contact information Jones: jjones2@emory.edu using a PGA for at least 12 months with a visually significant cataract that did not preclude evaluation of the fundus. Additionally, the patient could not have preexisting macular edema as demonstrated by SD-OCT on the day of surgery. Eyes were excluded if there was any preexisting ocular disease, history of clinical or angiographic macu- lar edema, or previous intraocular surgery on the study eye. The PGA was used throughout the periopera- tive period. Additionally, all patients received postoperative prednisolone acetate and chloramphenicol four times per day for 4 weeks. Standard examination techniques including Snellen acuity, slit lamp biomicros- copy with applanation tonometry, and dilated fundus examinations were performed at each visit, as well as advanced diagnostics including central retinal thickness. The main outcome measures were the presence or absence of clinical and subclinical CME. The authors described subclini- cal macular edema as low-intensity cystic spaces within the retina not visible with slit lamp biomicroscopy that did not reduce visual acuity. SD-OCT images were obtained preoperatively on the day of surgery and again at 3 and 6 weeks postoper- atively. Statistical analyses including Wilcoxon signed rank tests were used. Sixty eyes of 48 patients were analyzed, with the average patient age of 78.4 years and the gender leaning toward female at 65%. Latanoprost was the most common- ly used PGA (49 eyes) followed by bimatoprost (14 eyes), combination bimatoprost/timolol (three eyes), and tafluprost (one eye). No clinical CME was present at any point in the study. Subclinical/SD-OCT findings were seen in two separate patients using latanoprost: one eye at 3 weeks and another eye in a different patient at 6 weeks postoperatively. Both patients' OCT findings resolved within 8 weeks with topical NSAID and steroid therapy. The average preoperative central retinal thick- ness (CRT) for the cohort was 254, while postoperative CRT at 3 weeks was 267 and at 6 weeks was 268. The difference between preoperative and 6-weeks postoperative CRT was statistically significant. Comments As the first prospective study evalu- ating the incidence of CME in cata- ract surgery in patients using PGAs, this study provides an important baseline. The study results suggest that perioperative PGA use in an average patient without underlying pathology may not alter the expect- ed CME rate after routine cataract surgery. However, the lack of control and the small sample size make generalizability difficult. Addition- ally, the results are not normalized Review continued from page 78 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 Andrew Walkden, MBChB, Louise Porter, MBChB, Jiten Morarji, MBChB, Simon Kelly, FRCOphth, Evangelos Sioras, FRCOphth J Cataract Refract Surg. 2017;43(8). Article in press Purpose: To define the incidence of cystoid macular edema (CME) and OCT-detectable subclinical changes in central macular thickness in patients using prostaglandin analogue (PGA) eye drops after standard phacoemulsification surgery. Setting: An ophthalmic unit within a National Health Service, U.K. Design: Prospective observational study. Methods: Consecutive analysis of the incidence of postoperative CME after phacoemulsification surgery by a single surgeon was performed in eyes of patients using a PGA eye drop between March 2010 and January 2014. Presence of CME was determined clinically and using optical coherence tomography (OCT) at 3 and 6 weeks postoperatively. All patients underwent uncomplicated cataract surgery. Exclusion criteria included eyes with preexisting pathology known to predispose to CME and eyes that had undergone previous ophthalmic surgery. A paired Wilcoxon signed ranks test was used to compare central retinal thickness measurements at baseline and 3 and 6 weeks postoperatively. Results: 60 eyes of 48 patients (65% female) were prospectively analyzed. Mean age was 78.4 years. There were no cases of clinically significant CME. OCT-detectable subclinical CME was confirmed postoperatively in two eyes of different patients (3.3% of operated eyes), one at 3 and another at 6 weeks postoperatively. Subclinical CME resolved in both cases within 8 weeks. In both cases, the difference in central retinal thickness at baseline and 6 weeks postoperatively was significant (P<0.05). Conclusions: The incidence of OCT-detectable subclinical CME following routine phacoemulsification surgery in patients using a PGA eye drop throughout the perioperative period was 3.3%. There were no cases of clinical CME. These findings may guide clinicians in their decision to use PGAs in the perioperative period. insertion between March 2010 and January 2014. The decision to use a single site and single surgeon reduced the number of eyes in- cluded in the study but minimized potentially confounding factors. A prospective study follows a group over time to determine whether cer- tain factors affect rates of a specific outcome. A control cohort was not utilized in this study as the authors felt the control data in the literature was sufficient. The inclusion criteria included eyes with ocular hypertension or pri- mary open-angle glaucoma (POAG)

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