[Macular edema after an uncomplicated cataract surgery]. / Makulární edém po nekomplikované operaci katarakty.

PURPOSE: To characterize the macular thickness changes after an uncomplicated cataract surgery measured by means of optical coherence tomography (OCT), to specify the incidence of cystoid macular edema (CME), and to attempt to establish a correlation between the retinal thickening after an operation and possible risk factors for its development. PATIENTS AND METHODS: This study comprised 100 patients (64 women and 36 men) with the mean age of 70 (70.08 +/- 9.37 [SD] years; range, 44-85 years). All patients underwent uneventful phacoemulsification, which was followed by in the bag intraocular lens implantation. The real phacoemulsification time and the duration of the entire surgical procedure were recorded. The operated eye was set into the study group; the contralateral, non operated eyes formed a control group. The patients were clinically assessed with Stratus OCT examination preoperatively, and on day 1, in week 1, and in months 1, 2, 3 and 6 postoperatively. Foveal (central area 1mm in diameter), inner macular (ring area between 1mm and 3mm in diameter), outer macular (ring area between 3mm and 6mm in diameter) thickness and macular volume were analyzed. RESULTS: An increase in retinal thickness and macular volume after the cataract surgery reached the maximum in months 1 and 2 in all examined areas. Since month 3 on, there was a progressive decrease of abnormal retinal thickness and macular volume. An increase in retinal thickness was proved to be most prominent in the inner macular area. An increase in macular volume and retinal thickness in inner and outer macular area were statistically significant in months 1, 2 and 3 (Student t-test, p < 0.001; [p = 0.01 for the data in month 3]), while an increase in retinal thickness in foveal area was statistically significant in months 1 and 2 (Student t-test, p < 0.05). Six months after the surgery, the difference was not statistically significant in any of the examined areas. Three patients (3 %) developed CME after the phacoemulsification, but in one patient (1 %) only the clinical CME with some degree of a visual loss 1 month after the surgery (BCVA = 0.5) was diagnosed. There was a positive statistical correlation between the real phacoemulsification time and the increase in macular volume and retinal thickness in fovea and inner macular area in week one, and in months one and two after the surgery (Spearman's correlation test, p < 0.05). A positive statistical correlation was also found between the overall duration of the surgical procedure and the increase in macular volume and retinal thickness in all areas one month after the surgery (Spearman's correlation test, p < 0.05). CONCLUSION: The results indicate that changes in retinal thickness in macular area must be taken into account even after an uncomplicated cataract surgery. The increase in retinal thickness and macular volume reached the maximum in months 1 and 2 and tends to decrease since month 3 on. There is a positive statistical correlation between the retinal thickness increase and the real phacoemulsification time as well as between the retinal thickness increase and the overall duration of the surgical procedure. The incidence of CME was 3 %, but clinically significant CME was detected in 1 % of the cases only. Topical application of non-steroid, anti-inflammatory drugs can be important to effectively prevent the CME development after an uneventful cataract surgery.

[Macular edema after cataract surgery in diabetic patients without retinopathy]. / Makulární edém po operaci katarakty u diabetiku bez diabetické retinopatie.

PURPOSE: To study the effect of phacoemulsification on the development of macular edema and diabetic retinopathy in diabetic patients without preoperative retinopathy. PATIENTS AND METHODS: This study comprised 86 patients; 26 diabetics, who had no clinically detectable diabetic retinopathy preoperatively, formed a study group and 60 non-diabetics were included into the control group. Diabetes mellitus duration, preoperative hemoglobin A1c level, and diabetes treatment method were recorded in diabetics. Monocular cataract surgery was performed in all patients. The patients were clinically assessed with OCT examination preoperatively, and postoperatively on day 1, in week 1, and in months 1, 2, 3 and 6 respectively. Foveal, inner macular, outer macular thickness, and macular volume were analyzed. RESULTS: The increase of the retinal thickness after the cataract surgery reached maximum in both groups in months 1 and 2. Since month 3 on, there was a progressive decrease in abnormal retinal thickness. There was a significant major increase in retinal thickness in diabetics in all examined areas in month 2 (p < 0.05 for fovea and inner macula; p = 0.001 for outer macula and p = 0.005 for macular volume changes). Trend toward major increase in retinal thickness in diabetics was still evident even three months after the surgery. In no case did a diabetic eye develop clinically detectable diabetic retinopathy during the follow-up period. The correlation between hemoglobin A1c level and retinal thickness changes in diabetics was not significant. There was also no significant difference in final visual acuity between diabetics and non-diabetics. CONCLUSION: We can expect similar induced retinal thickness changes in diabetics without retinopathy as in non-diabetics after uneventful cataract surgery, though there was a trend toward major increase in retinal thickness in diabetics.