Visually Significant Cystoid Macula Edema after Glaucoma Drainage Implant Surgery

Amitabha S. Bhakta, Jorge Fortun, Julien Thomas, Anthony Greer, Krishna Kishor, Arindel S Maharaj

Research output: Contribution to journalArticle

Abstract

Purpose: This study examines the incidence of visually significant cystoid macular edema (CME) after glaucoma drainage implant (GDI) surgery and analyses risk factors associated with developing CME and prognosis with treatment. Materials and Methods: In total, 185 eyes from 185 glaucoma patients (mean age, 72.46±13.94 y) who underwent GDI surgery at a tertiary eye institute were recruited. Patients were classified based on the presence (CME) or absence (No-CME) of CME. Pre-GDI and post-GDI best-corrected visual acuity, number of intraocular pressure (IOP)-lowering medications, IOP, standard automated perimetry and post-GDI complications, were recorded and compared between the 2 groups. Optical coherence tomography (OCT) was used to quantify retinal thickness and monitor CME. Results: In total, 41 (22.2%) eyes developed visually significant CME after GDI surgery. Patients with CME had a higher incidence of pre-GDI nonsteroidal anti-inflammatory drug (P<0.01) use and higher number of prior glaucoma surgeries (P<0.01). CME patients had a higher (P<0.01) incidence of iritis, epiretinal membrane, and hypotony. CME eyes responded well to steroids, with resolving macular edema (458.4±151.9 vs. 322.0±92.0 μm, P<0.01) and improving visual acuity (0.73±0.48 vs. 0.56±0.56 logarithm of minimum angle of resolution, P<0.01). Both CME and non-CME groups had equivalent lowering of IOP and post-GDI glaucoma medications; with no significant elevation in IOP in the steroid-treated CME group. Conclusions: Post-GDI surgery visually significant CME rates are potentially higher in a real hospital scenario compared with controlled clinical trials. With diligent treatment, CME resolves effectively restoring visual acuity and central macular thickness.

Original languageEnglish (US)
Pages (from-to)184-188
Number of pages5
JournalJournal of Glaucoma
Volume27
Issue number2
DOIs
StatePublished - Jan 1 2018

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Glaucoma Drainage Implants
Macular Edema
Edema
Intraocular Pressure
Glaucoma
Visual Acuity
Steroids
Iritis
Epiretinal Membrane

Keywords

  • cystoid macular edema (CME)
  • glaucoma drainage implant (GDI)
  • intraocular pressure (IOP)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Visually Significant Cystoid Macula Edema after Glaucoma Drainage Implant Surgery. / Bhakta, Amitabha S.; Fortun, Jorge; Thomas, Julien; Greer, Anthony; Kishor, Krishna; Maharaj, Arindel S.

In: Journal of Glaucoma, Vol. 27, No. 2, 01.01.2018, p. 184-188.

Research output: Contribution to journalArticle

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abstract = "Purpose: This study examines the incidence of visually significant cystoid macular edema (CME) after glaucoma drainage implant (GDI) surgery and analyses risk factors associated with developing CME and prognosis with treatment. Materials and Methods: In total, 185 eyes from 185 glaucoma patients (mean age, 72.46±13.94 y) who underwent GDI surgery at a tertiary eye institute were recruited. Patients were classified based on the presence (CME) or absence (No-CME) of CME. Pre-GDI and post-GDI best-corrected visual acuity, number of intraocular pressure (IOP)-lowering medications, IOP, standard automated perimetry and post-GDI complications, were recorded and compared between the 2 groups. Optical coherence tomography (OCT) was used to quantify retinal thickness and monitor CME. Results: In total, 41 (22.2{\%}) eyes developed visually significant CME after GDI surgery. Patients with CME had a higher incidence of pre-GDI nonsteroidal anti-inflammatory drug (P<0.01) use and higher number of prior glaucoma surgeries (P<0.01). CME patients had a higher (P<0.01) incidence of iritis, epiretinal membrane, and hypotony. CME eyes responded well to steroids, with resolving macular edema (458.4±151.9 vs. 322.0±92.0 μm, P<0.01) and improving visual acuity (0.73±0.48 vs. 0.56±0.56 logarithm of minimum angle of resolution, P<0.01). Both CME and non-CME groups had equivalent lowering of IOP and post-GDI glaucoma medications; with no significant elevation in IOP in the steroid-treated CME group. Conclusions: Post-GDI surgery visually significant CME rates are potentially higher in a real hospital scenario compared with controlled clinical trials. With diligent treatment, CME resolves effectively restoring visual acuity and central macular thickness.",
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