Transient corneal edema is a predictive factor for pseudophakic cystoid macular edema after uncomplicated cataract surgery

Abstract

Purpose: To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME).

Methods: A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery.

Results: Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery.

Conclusions: Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.

Keywords: Cataract; Corneal edema; Macular edema; Phacoemulsification; Risk factors.

Fig. 1

Image of corneal anterior segment 5-line raster scans from an 80-year-old male before and after uncomplicated phacoemulsification surgery. (A) Preoperative anterior optical coherence tomography (OCT) image. The anterior and posterior surfaces of the cornea had a continuous, smooth contour. (B) Anterior OCT of the cornea one week after surgery. The corneal anterior surface had a continuous, smooth contour, while the posterior corneal surface had 5 points of irregular wave-like appearance (arrows) compared to the posterior virtual contour (red colored dotted lines). (C) Anterior OCT of the cornea one month after surgery. All points of the irregular posterior surface resolved and appeared smooth again. I = inferior; N = nasal; S = superior; T = temporal.

Fig. 2

Macular scan image of the same patient in Fig. 1. (A) Preoperative macular cube scan image. The central subfield retinal thickness (CRT) was 267 µm, and the fovea did not show retinal thickening or cystoid change. (B) Image of macular cube scan 1 month after surgery. CRT increased to 324 µm. The normal foveal depression disappeared, and the images show cystoid change at the fovea (arrows). I = inferior; N = nasal; S = superior; T = temporal.