Cystoid macular edema after low-energy femtosecond-assisted cataract surgery

Abstract

Purpose: This study aimed to evaluate the occurrence of pseudophakic cystoid macular edema (PCME) post low-energy femtosecond laser-assisted cataract surgery (FLACS) in a high-volume surgical setting.

Methods: The medical records of 242 FLACS patients were retrospectively reviewed. The central subfield macular thickness (CSMT) was measured via optical coherence tomography (OCT) before and 4-6 weeks after surgery, and the results were compared for PCME detection. Macular edema was defined as a 10% increase in CSMT, a new onset of intraretinal fluid, or a decrease in visual acuity (VA). VA development in PCME patients was reviewed at 2-3 months and 6 months.

Results: The median patient age was 72 years (49-92 years). Among 242 eyes, seven eyes (2.89%) developed PCME. The median preoperative CSMT in these eyes was 255 μm (minimum 231 μm, maximum 326 μm), whereas the median CSMT at 4-6 weeks after surgery was 317 μm (minimum 255 μm, maximum 463 μm). 4- to 6-week postoperative visual acuity decreased in comparison with 1-week postoperative values in three eyes of two patients, remained stable in two patients, and improved in one patient, whereas one patient did not return for his 1-week appointment but improved from 0.4 to 0.2 logMAR 2.5 months postoperatively. By 3-6 months, all eyes with PCME had gained visual acuity in comparison with their preoperative values. None of the PCME patients had diabetes or used prostaglandin analogues. Three patients were receiving anticoagulation medication.

Conclusion: A 2.89% incidence of PCME after low-energy FLACS matched published standard phacoemulsification rates. In our series of uncomplicated cases, PCME caused only a transient postoperative decrease in visual acuity.

Key messages: What is known Increased prostaglandin levels have been detected in the aqueous humour of cataract patients after femtosecond laser application. Prostaglandins are mediators of inflammation. Femtosecond lasers come in low energy and high energy variants. There is contrasting evidence of increased incidence of PCME after femtosecond laser assisted cataract surgery (FLACS) What is new The incidence of PCME after low-energy FLACS in our high volume surgical setting is 2.89% Low-energy FLACS does not seem to have a causative effect on PCME.

Keywords: Cataract surgery; Femtosecond laser; Low-energy femtosecond laser; Macular thickness; Posterior uveitis; Pseudophakic cystoid macular edema; Risk factors.