Incidence of Postvitrectomy Macular Edema Using Optical Coherence Tomography
Received 9 September 2008; received in revised form 4 February 2009; accepted 4 February 2009. published online 05 June 2009.
Objective
To evaluate the incidence, effect on visual recovery, and predisposing risk factors of postvitrectomy macular edema (ME).
Design
Prospective cohort study.
Participants
One-hundred nine eyes undergoing nonemergent vitrectomy surgery.
Methods
Eyes were evaluated for postoperative day 1 inflammation, 1-month retinal thickness using optical coherence tomography, and preoperative and 1-month postoperative best-corrected visual acuity (BCVA). Macular edema was defined as central subfield thickness ≥272 μm.
Main Outcome Measures
Retinal thickness, inflammation, and BCVA.
Results
Incidence of ME on optical coherence tomography was 47% (95% confidence interval [CI], 37%–56%). Mean 1-month visual acuity improved 3.3 lines (0.33 logarithm of minimum angle of resolution [logMAR] units) to 20/80+1 (0.58±0.46 logMAR units) from 20/150–2 (0.91±0.63 logMAR units) before surgery (P<0.001). Mean 1-month center point thickness (CPT), central subfield (CSF), and total macular volume were 265±107 μm, 288±94 μm, and 7.8±1.2 mm3, respectively. Severity of postoperative inflammation predicted retinal thickness at 1 month (P<0.05). Intraoperative epinephrine use was associated with increased postoperative inflammation (P = 0.02). Eyes with greater reduction in CSF (or CPT) from baseline experienced more rapid visual recovery (r = –0.36; 95% CI, –0.61 to –0.06; P = 0.02).
Conclusions
Postvitrectomy ME is common and delays visual recovery. Degree of postoperative inflammation is an important risk factor for ME and, in this series, was increased in the setting of intraocular epinephrine. Efforts to reduce or prevent inflammation after vitrectomy should be beneficial and therefore are encouraged.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Available online: June 5, 2009.
1Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
2Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
Correspondence: Stephen J. Kim, MD, Vanderbilt Eye Institute, 2311 Pierce Avenue, Nashville, TN 37232
Manuscript no. 2008-1085.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York; the Heed Foundation (SJK); and the Ronald G. Michels Foundation (SJK). Dr Hubbard is a paid consultant for Genentech Corporation (South San Francisco, CA) and Theragenics Corporation (Buford, GA). Dr Srivastava is a paid consultant for Bausch & Lomb (Rochester, NY).
ABSTRACT