Persistent Postoperative Cystoid Macular Edema After Pars Plana Vitrectomy for Retinal Detachment


ABSTRACT

Purpose:

Postoperative cystoid macular edema (CME) can occur after intraocular surgery, including pars plana vitrectomy (PPV). In most cases CME remains subclinical or decreases spontaneously, however in some cases it can persist and be very difficult to treat, affecting the visual rehabilitation. In this study we aim to analyse the risk factors that predispose for persistent CME after pars plana vitrectomy for retinal detachment.

Methods:

For this study a retrospective case series of 15 eyes that developed persistent postoperative CME after PPV for a primary rhegmatogenous retinal detachment, was analysed and compared to a control group. Persistent CME was defined as CME that persisted for more than 6 months after surgery with a central foveal thickness of ≥274. Patients with pre-existent CME, or systemic causes for CME were excluded. The control group included 75 eyes that were matched for surgical indication, age and gender before randomly being selected from the hospital database with SPSS. Pre-, peri- and postoperative patient characteristics including phakic status, PVR grade, type and number of retinal tears, macular detachment, duration of macular detachment, ILM peeling, Perfluorcarbon use, type of tamponade, duration of tamponade and number of reoperations were analysed in a multivariate analysis using SPSS software.

Results:

Giant tears (Odds Ratio 28.8; p = 0.013), multiple retinal tears (Odds ratio 2.2; p = 0.022) and silicone Oil 1000 cSt (Odds ratio 9.6; p = 0.016) are significantly correlated with the derivation of postoperative persistent CME. The other factors, including Silicone Oil 5700 cSt (p = 0,420) were not significantly associated with postoperative persistent CME.

Conclusion:

Patients operated for a retinal detachment with giant tear and/or multiple defects have a significant higher risk in developing persistent postoperative CME after PPV. When silicone oil is chosen as a tamponade for these cases, surgeons should favor the use of Silicone Oil 5700 cSt over 1000 cSt when these predisposing risk factors are present.


CONTACT DETAILS

 

Niels Crama
Nijmegen, Netherlands
Email : niels.crama@radboudumc.nl
Cell Phone: +31624543496
Work Phone: +31243614448