ANALYSIS OF CYSTOID MACULAR EDEMA AFTER CATARACT SURGERY

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Analysis of Cystoid Macular Edema after Cataract Surgery in Patients with and without Uveitis using Optical Coherence Tomography. Division of Ocular Immunology, Wilmer Eye Institute, Johns Hopkins Hospital. Introduction: Uveitis is the sixth leading cause of visual impairment in developed countries. Cataract formation is common in uveitis, and cystoid macular edema (CME) is a major cause of long-term visual loss after cataract surgery. Optical coherence tomography (OCT) is a new method for high-resolution cross-sectional imaging that directly measures retinal thickness. OCT has been shown to be highly reproducible and is well tolerated, safe and quick to perform. Although widely recognized, the true incidence of CME in patients with uveitis after cataract surgery has not been clearly defined. Incidence of CME determined from OCT testing may allow for more precise risk stratification, and translate into more timely treatment and targeted prophylaxis for high-risk patients. Objectives: The objectives of this study are: 1) To assess the incidence and progression of CME after cataract surgery in patients with uveitis using OCT and to correlate this with the type of uveitis and other known risk factors. 2) To compare the incidence or progression of CME after cataract surgery between patients with and without uveitis using OCT. Methods: Study participants consist of a consecutive cohort of patients with uveitis and without uveitis (control group) scheduled for routine cataract surgery. A total of 50 patients will be enrolled in each group. Patients included in the uveitis group have documented evidence of non-infectious chronic uveitis (duration more than 3 months) or recurrent uveitis (2 or more episodes, separated by at least 3 months) involving one or more segments of the eye (anterior, intermediate, posterior). Patients without a prior history of uveitis are eligible for inclusion in the control group. For both groups, subjects with an established diagnosis of diabetes or other retinal pathology affecting macular thickness are excluded. For each study eye, OCT testing is performed no more than 4 weeks prior to the date of surgery, 1 month after the surgery and 3 months after the surgery. Clinical examination including best corrected visual acuity, ocular inflammation and fundus examination, is recorded for pre-operative visit, and post-operative 1 and 3 months visits. Patient characteristics, including age, gender, race, type and duration of uveitis, past ocular and medical history, medication use, peri-operative administration of corticosteroids and other immunosuppressive agents, type and complications of surgery, are recorded for each study eye. The Fisher's exact test will be used to analyze proportion of participants developing CME at 1 and 3 months among the uveitis and control groups. Secondary outcomes such as mean changes in foveal thickness and visual acuity will be compared among groups using the Wilcoxon test. Regression models will be used to investigate statistical associations between the incidence of CME and related risk factors such as duration of uveitis, prior history of macular edema, and anatomical location of uveitis. Results: The results are not available. Conclusions: Information obtained from this study may allow us to correlate incidence and progression of CME after cataract surgery with type of uveitis and other risks factors. We hope this study provides information that translates into early treatment and targeted prophylaxis for CME after cataract surgery in high-risk patients.