Macular edema after rhegmatogenous retinal detachment repair: risk factors, OCT analysis, and treatment responses

International Journal of Retina and Vitreous - 2021
Cameron Pole1, Ismaël Chehaibou1, Andrea Govetto2, Sean T. Garrity3, Steven D. Schwartz1, Jean‐Pierre Hubschman1
1Retina Division, Stein Eye Institute, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA, 90095-7002, USA
2Ophthalmology Department, Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy
3Tufts Medical Center/New England Eye Center, Ophthalmic Consultants of Boston, Boston, MA, USA

Tóm tắt

Abstract Purpose To investigate risk factors, imaging characteristics, and treatment responses of cystoid macular edema (CME) after rhegmatogenous retinal detachment (RRD) repair. Methods Consecutive, retrospective case–control series of patients who underwent pars plana vitrectomy (PPV) and/or scleral buckling (SB) for RRD, with at least six months of follow-up. Clinical and surgical parameters of patients with and without CME (nCME), based on spectral-domain optical coherence tomography (OCT), were compared. Results Of 99 eyes enrolled, 25 had CME while 74 had nCME. Patients with CME underwent greater numbers of surgeries (P < 0.0001). After adjusting for number of surgeries, macula-off RRD (P = 0.06), proliferative vitreoretinopathy (PVR) (P = 0.09), surgical approach (PPV and/or SB, P = 0.21), and tamponade type (P = 0.10) were not statistically significant, although they all achieved significance on univariate analysis (P = 0.001 or less). Intraoperative retinectomy (P = 0.009) and postoperative pseudophakia or aphakia (P = 0.008) were more frequent in the CME group, even after adjustment. Characteristics of cCME on OCT included diffuse distribution, confluent cysts, and absence of subretinal fluid or intraretinal hyperreflective foci. Macular thickness improved significantly with intravitreal triamcinolone (P = 0.016), but not with anti-vascular endothelial growth factor agents (P = 0.828) or dexamethasone implant (P = 0.125). After adjusting for number of surgeries and macular detachment, final visual acuities remained significantly lower in the CME vs nCME group (P = 0.012). Conclusion Risk factors of CME include complex retinal detachment repairs requiring multiple surgeries, and pseudophakic or aphakic lens status. Although this cCME was associated with poor therapeutic response, corticosteroids were the most effective studied treatments.

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Tài liệu tham khảo

Daruich A, Matet A, Moulin A, et al. Mechanisms of macular edema: beyond the surface. Prog Retin Eye Res. 2018;63:20–68.

Spaide RF. Retinal vascular cystoid macular edema: review and new Theory. Retina. 2016;36(10):1823–42.

Romano V, Angi M, Scotti F, et al. Inflammation and macular oedema after pars plana vitrectomy. Mediators Inflamm. 2013;2013:971758.

Catier A, Tadayoni R, Paques M, et al. Characterization of macular edema from various etiologies by optical coherence tomography. Am J Ophthalmol. 2005;140(2):200–6.

Bonnet M. Prognosis of cystoid macular edema after retinal detachment repair. Graefes Arch Clin Exp Ophthalmol. 1986;224(1):13–7.

Meredith TA, Reeser FH, Topping TM, et al. Cystoid macular edema after retinal detachment surgery. Ophthalmology. 1980;87(11):1090–5.

Bonnet M, Payan X. Long-term prognosis of cystoid macular edema after microsurgery of rhegmatogenous retinal detachment. J Fr Ophtalmol. 1993;16(4):259–63.

de Nie KF, Crama N, Tilanus MA, et al. Pars plana vitrectomy for disturbing primary vitreous floaters: clinical outcome and patient satisfaction. Graefes Arch Clin Exp Ophthalmol. 2013;251(5):1373–82.

Miyake K, Miyake Y, Maekubo K, et al. Incidence of cystoid macular edema after retinal detachment surgery and the use of topical indomethacin. Am J Ophthalmol. 1983;95(4):451–6.

Benson SE, Ratclliffe S, Van Raders P, et al. A randomized comparison of parecoxib/valdecoxib and placebo for the prevention of cystoid macular edema after scleral buckling surgery. Retina. 2009;29(3):387–94.

Lai TT, Huang JS, Yeh PT. Incidence and risk factors for cystoid macular edema following scleral buckling. Eye. 2017;31(4):566–71.

Rossetti L, Chaudhuri J, Dickersin K. Medical prophylaxis and treatment of cystoid macular edema after cataract surgery. The results of a meta-analysis. Ophthalmology. 1998;105(3):397–405.

Munk MR, Sacu S, Huf W, et al. Differential diagnosis of macular edema of different pathophysiologic origins by spectral domain optical coherence tomography. Retina. 2014;34(11):2218–32.

Schulze-Bonsel K, Feltgen N, Burau H, et al. Visual acuities “hand motion” and “counting fingers” can be quantified with the freiburg visual acuity test. Invest Ophthalmol Vis Sci. 2006;47(3):1236–40.

Augustin A, Loewenstein A, Kuppermann BD. Macular edema. General pathophysiology. Dev Ophthalmol. 2010;47:10–26.

Thanos A, Todorich B, Yonekawa Y, et al. Dexamethasone intravitreal implant for the treatment of recalcitrant macular edema after rhegmatogenous retinal detachment repair. Retina. 2018;38(6):1084–90.

Yang JY, Kim HK, Kim SH, et al. Incidence and Risk Factors of Cystoid Macular Edema after Vitrectomy with Silicone Oil Tamponade for Retinal Detachment. Korean J Ophthalmol. 2017.

Tunc M, Lahey JM, Kearney JJ, et al. Cystoid macular oedema following pneumatic retinopexy vs scleral buckling. Eye. 2007;21(6):831–4.

Siegfried CJ, Shui YB, Tian B, et al. Effects of vitrectomy and lensectomy on older rhesus macaques: oxygen distribution, antioxidant status, and aqueous humor dynamics. Invest Ophthalmol Vis Sci. 2017;58(10):4003–14.

Kiss CG, Richter-Muksch S, Sacu S, et al. Anatomy and function of the macula after surgery for retinal detachment complicated by proliferative vitreoretinopathy. Am J Ophthalmol. 2007;144(6):872–7.

Pastor JC, Rojas J, Pastor-Idoate S, et al. Proliferative vitreoretinopathy: a new concept of disease pathogenesis and practical consequences. Prog Retin Eye Res. 2016;51:125–55.

Nakanishi H, Hangai M, Unoki N, et al. Spectral-domain optical coherence tomography imaging of the detached macula in rhegmatogenous retinal detachment. Retina. 2009;29(2):232–42.

Lee SY, Joe SG, Kim JG, et al. Optical coherence tomography evaluation of detached macula from rhegmatogenous retinal detachment and central serous chorioretinopathy. Am J Ophthalmol. 2008;145(6):1071–6.

Gaudric A, Haouchine B, Massin P, et al. Macular hole formation: new data provided by optical coherence tomography. JAMA Ophthalmology. 1999;117(6):744–51.

Alam MR, Arcinue CA, Mendoza NB, et al. Recalcitrant cystoid macular edema after pars plana vitrectomy. Retina. 2016;36(7):1244–51.

Gharbiya M, Grandinetti F, Scavella V, et al. Correlation between spectral-domain optical coherence tomography findings and visual outcome after primary rhegmatogenous retinal detachment repair. Retina. 2012;32(1):43–53.

Kim BY, Smith SD, Kaiser PK. Optical coherence tomographic patterns of diabetic macular edema. Am J Ophthalmol. 2006;142(3):405–12.

Edington M, Connolly J, Chong NV. Pharmacokinetics of intravitreal anti-VEGF drugs in vitrectomized versus non-vitrectomized eyes. Expert Opin Drug Metab Toxicol. 2017;13(12):1217–24.

Chin HS, Park TS, Moon YS, et al. Difference in clearance of intravitreal triamcinolone acetonide between vitrectomized and nonvitrectomized eyes. Retina. 2005;25(5):556–60.

Lobes LA Jr, Grand MG. Incidence of cystoid macular edema following scleral buckling procedure. Arch Ophthalmol. 1980;98(7):1230–2.

Banerjee PJ, Quartilho A, Bunce C, et al. Slow-release dexamethasone in proliferative vitreoretinopathy: a prospective. Randomized Controlled Clinical Trial. Ophthalmology. 2017;124(6):757–67.

Guo S, Patel S, Baumrind B, et al. Management of pseudophakic cystoid macular edema. Surv Ophthalmol. 2015;60(2):123–37.

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International Journal of Retina and Vitreous

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