Improving visual outcomes by preserving outer retina morphology in eyes with resolved pseudophakic cystoid macular edema

Allan A. Hunter, Sara P. Modjtahedi, Kuumba Long, Robert Zawadzki, Eric K. Chin, Jeffrey J Caspar, Lawrence S Morse, David G. Telander

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose To use ultra-high-resolution optical coherence tomography (OCT) subclinical anatomic alterations to explain suboptimum vision despite pseudophakic cystoid macula edema (CME) resolution. Setting University of California-Davis, Sacramento, California, USA. Design Case study. Methods This study comprised patients who had cataract phacoemulsification surgery. Cases of resolved postoperative CME (diagnosed postoperatively by 1 month and resolved by 1 year) were included. Exclusion criteria included any other cause for decreased vision or compounding factors. Patients with a history of resolved pseudophakic CME were imaged using a purpose-built ultra-high-resolution OCT system with 4.5 μm axial resolution and an acquisition speed of 9 frames/sec (1000 A-scans/frame). The corrected distance visual acuity (CDVA) was determined by Early Treatment Diabetic Retinopathy Study standards. Statistical analysis was by the unpaired t test. A P value less than 0.05 was considered significant. Results The review identified 56 patients with a pseudophakic CME diagnosis at least 1 month postoperatively. Fifteen eyes (26.8%) had less than 20/20 CDVA despite resolution of CME; 7 participated. Four patients with 20/20 CDVA after resolution of pseudophakic CME participated. Eyes with reduced CDVA after macula edema showed ultra-high-resolution OCT evidence of blurring of outer segments of photoreceptors, while controls showed normal outer retina morphology (P <.05). Conclusions Persistent anatomic alteration of photoreceptors visualized by ultra-high-resolution OCT correlated with reduced CDVA in patients with pseudophakic CME compared with patients who had 20/20 CDVA after macula edema. This anatomic alteration in outer photoreceptor morphology is a plausible explanation for the reduced CDVA in this disease. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Original languageEnglish (US)
Pages (from-to)626-631
Number of pages6
JournalJournal of Cataract and Refractive Surgery
Volume40
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Macular Edema
Retina
Edema
Visual Acuity
Optical Coherence Tomography
Phacoemulsification
Disclosure
Diabetic Retinopathy
Cataract

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Surgery

Cite this

Improving visual outcomes by preserving outer retina morphology in eyes with resolved pseudophakic cystoid macular edema. / Hunter, Allan A.; Modjtahedi, Sara P.; Long, Kuumba; Zawadzki, Robert; Chin, Eric K.; Caspar, Jeffrey J; Morse, Lawrence S; Telander, David G.

In: Journal of Cataract and Refractive Surgery, Vol. 40, No. 4, 2014, p. 626-631.

Research output: Contribution to journalArticle

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abstract = "Purpose To use ultra-high-resolution optical coherence tomography (OCT) subclinical anatomic alterations to explain suboptimum vision despite pseudophakic cystoid macula edema (CME) resolution. Setting University of California-Davis, Sacramento, California, USA. Design Case study. Methods This study comprised patients who had cataract phacoemulsification surgery. Cases of resolved postoperative CME (diagnosed postoperatively by 1 month and resolved by 1 year) were included. Exclusion criteria included any other cause for decreased vision or compounding factors. Patients with a history of resolved pseudophakic CME were imaged using a purpose-built ultra-high-resolution OCT system with 4.5 μm axial resolution and an acquisition speed of 9 frames/sec (1000 A-scans/frame). The corrected distance visual acuity (CDVA) was determined by Early Treatment Diabetic Retinopathy Study standards. Statistical analysis was by the unpaired t test. A P value less than 0.05 was considered significant. Results The review identified 56 patients with a pseudophakic CME diagnosis at least 1 month postoperatively. Fifteen eyes (26.8{\%}) had less than 20/20 CDVA despite resolution of CME; 7 participated. Four patients with 20/20 CDVA after resolution of pseudophakic CME participated. Eyes with reduced CDVA after macula edema showed ultra-high-resolution OCT evidence of blurring of outer segments of photoreceptors, while controls showed normal outer retina morphology (P <.05). Conclusions Persistent anatomic alteration of photoreceptors visualized by ultra-high-resolution OCT correlated with reduced CDVA in patients with pseudophakic CME compared with patients who had 20/20 CDVA after macula edema. This anatomic alteration in outer photoreceptor morphology is a plausible explanation for the reduced CDVA in this disease. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.",
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AB - Purpose To use ultra-high-resolution optical coherence tomography (OCT) subclinical anatomic alterations to explain suboptimum vision despite pseudophakic cystoid macula edema (CME) resolution. Setting University of California-Davis, Sacramento, California, USA. Design Case study. Methods This study comprised patients who had cataract phacoemulsification surgery. Cases of resolved postoperative CME (diagnosed postoperatively by 1 month and resolved by 1 year) were included. Exclusion criteria included any other cause for decreased vision or compounding factors. Patients with a history of resolved pseudophakic CME were imaged using a purpose-built ultra-high-resolution OCT system with 4.5 μm axial resolution and an acquisition speed of 9 frames/sec (1000 A-scans/frame). The corrected distance visual acuity (CDVA) was determined by Early Treatment Diabetic Retinopathy Study standards. Statistical analysis was by the unpaired t test. A P value less than 0.05 was considered significant. Results The review identified 56 patients with a pseudophakic CME diagnosis at least 1 month postoperatively. Fifteen eyes (26.8%) had less than 20/20 CDVA despite resolution of CME; 7 participated. Four patients with 20/20 CDVA after resolution of pseudophakic CME participated. Eyes with reduced CDVA after macula edema showed ultra-high-resolution OCT evidence of blurring of outer segments of photoreceptors, while controls showed normal outer retina morphology (P <.05). Conclusions Persistent anatomic alteration of photoreceptors visualized by ultra-high-resolution OCT correlated with reduced CDVA in patients with pseudophakic CME compared with patients who had 20/20 CDVA after macula edema. This anatomic alteration in outer photoreceptor morphology is a plausible explanation for the reduced CDVA in this disease. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

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