Cystoid macular edema after cataract surgery with intraocular vancomycin

Abstract

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.