Macular edema after cataract surgery in eyes with and without pseudoexfoliation syndrome

Background: The purpose of the study was to identify macular edema after cataract surgery in eyes with and without pseudoexfoliation syndrome. The study was a post-hoc analysis of a randomized, double-blind, prospective single-center study. Patients were enrolled between January 2016 and October 2016 as per the national guidelines for the management of cataract in the Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland. Methods: One hundred and fifty-six eyes of 149 patients undergoing routine cataract surgery. Postoperatively anti-inflammatory medication was either dexamethasone (N = 78) or diclofenac (N = 78). Spectral domain optical coherence tomography imaging and laser flare meter measurement of the anterior chamber were conducted before surgery and at the control visit 28 days postoperatively. Results: Baseline variables were comparable between eyes with pseudoexfoliation syndrome (N = 32) and those without (N = 124), except for intraocular pressure (P = 0.002) and glaucoma medication (P <0.001). In patients having pseudoexfoliation syndrome, central retinal thickness increase (mean +/- standard error of the mean) was 63.3 +/- 35.5 mu m for dexamethasone and 17.6 +/- 5.8 mu m for diclofenac, compared to 28.9 +/- 8.0 mu m (P = NS) and 6.9 +/- 1.3 mu m (P = 0.014) in eyes without pseudoexfoliation syndrome, respectively. Aqueous flare at 28 days was 25.8 +/- 5.4 pu/ms for patients with pseudoexfoliation syndrome and 18.3 +/- 1.8 pu/ms for those without (P = 0.030). Best corrected visual acuity gain and best corrected visual acuity at 28 days were less in patients having pseudoexfoliation syndrome compared to those without (0.39 +/- 0.07 vs 0.59 +/- 0.03 decimals, P = 0.007; and 0.77 +/- 0.06 vs 0.92 +/- 0.03 decimals, P = 0.008, respectively). Conclusion: Eyes with pseudoexfoliation syndrome may be predisposed to an increased aqueous flare and macular edema after cataract surgery. This study outlines the need to determine the optimal anti-inflammatory medication after cataract surgery in patients with pseudoexfoliation syndrome.Peer reviewe

Diabetes alone does not impair recovery from uneventful cataract surgery

Purpose To study the outcomes of uneventful cataract surgery in diabetic patients without retinal complications. Setting Conducted at Kymenlaakso Central Hospital, Kotka, Finland. Design A post-hoc treatment analysis using data from 2 double-blind RCTs. Methods A total of 276 eyes of 266 patients undergoing routine cataract surgery were included in the study. Patients with type I or II diabetes (N=56 eyes) were compared to non-diabetic patients (N=220 eyes). Clinical evaluation was conducted by the operating physician, and outcome measures taken before surgery and day 28 were recorded by a research technician. Results Patient age, gender distribution and all baseline ophthalmic and surgical parameters were comparable for the non-diabetic and diabetic patient groups. Increase in aqueous flare 6.3±16.4pu/msec vs. 3.7±8.9pu/msec (mean±SD; P=0.282), CRT 12.0±38.2μm vs. 5.9±15.8μm (P=0.256), corrected distance visual acuity 0.57±0.31decimals vs. 0.53±0.35decimals (P=0.259), and patient satisfaction 9.3±0.9 vs. 9.2±1.1 (P=0.644) were comparable for non-diabetic and diabetic patients. In eyes with steroid monotherapy (N=64), CRT increased 38.1±72.8μm in non-diabetic patients compared to 7.8±6.6μm in diabetic ones (P=0.010). In eyes with nonsteroidal anti-inflammatory drug (NSAID) monotherapy (N=157), CRT increased 5.7±18.4μm in non-diabetic patients compared to 6.2±20.5μm in diabetic ones (P=0.897). Among eyes with steroid and NSAID combination therapy (N=55), CRT increased 3.6±4.1μm in non-diabetic patients compared to 2.9±3.2μm in diabetic ones (P=0.606). At 28 days, pseudophakic cystoid macular edema (PCME) was reported in eight eyes, of which seven in non-diabetic patients (P=1.000). Conclusions Diabetic patients showed less changes in CRT when compared to controls in steroid monotherapy. Other outcome measurement shows no statistical differences.Peer reviewe