Combined procedures do not increase risk of pseudophakic CME

The combination of ab interno glaucoma surgery with phacoemulsification does not increase the risk of pseudophakic cystoid macular edema as compared with phacoemulsification alone, according to a study.

The retrospective study included 126 eyes that underwent cataract surgery combined with either trabecular aspiration (96 eyes) or Trabectome (30 eyes), and 234 eyes that received cataract surgery alone.

Phacoemulsification was performed in all cases using a standard bimanual technique through a 2.8-mm corneal incision followed by in-the-bag IOL implantation. Trabecular aspiration was performed after cataract extraction through the pre-existing paracenteses, while Trabectome (NeoMedix) preceded cataract surgery. Postoperatively, corticosteroids and antibiotics were used, with the addition of pilocarpine in the eyes that underwent Trabectome.

Spectral domain OCT examination was performed before surgery and at regular intervals after surgery in all eyes. Pseudophakic CME was detected in 23 eyes, of which seven had undergone combined surgery, five (5.2%) with trabecular aspiration and two (6.7%) with Trabectome, and 16 (6.8%) had undergone cataract surgery alone. The difference between combined surgery vs. cataract surgery alone and between cataract surgery and the individual glaucoma surgery procedures was not statistically significant.

However, patients with a history of pseudophakic CME were found to be at a higher risk of developing pseudophakic CME in the fellow eye.

“Low-risk patients with history of [pseudophakic] CME should be informed about the increased risk for [pseudophakic] CME in the fellow eye,” the authors suggested. They also emphasized the importance of an intense and close follow-up, while defining as “debatable” the administration of corticosteroids for postoperative prophylaxis in fellow eyes. – by Michela Cimberle

Disclosure: The authors report no relevant financial disclosures.

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Source:

Schaub F, et al. J Glaucoma. 2017;doi:10.1097/IJG.0000000000000586.