ANALYSIS OF CYSTOID MACULAR EDEMA AFTER CATARACT SURGERY

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。光学相干断层扫描对合并和不合并葡萄膜炎患者白内障术后黄斑囊样水肿的分析。约翰霍普金斯医院威尔默眼科研究所眼免疫学部。在发达国家，葡萄膜炎是造成视力损害的第六大原因。白内障的形成在葡萄膜炎中很常见，而囊样黄斑水肿（CME）是白内障手术后长期视力丧失的主要原因。光学相干断层扫描（OCT）是一种直接测量视网膜厚度的高分辨率横断面成像新方法。OCT具有高度可重复性，耐受性好，安全性好，操作迅速。尽管已被广泛认识，但白内障术后葡萄膜炎患者CME的真实发生率尚未明确界定。从OCT检测中确定CME的发生率可能允许更精确的风险分层，并转化为对高危患者更及时的治疗和有针对性的预防。目的：本研究的目的是：1)利用OCT评估葡萄膜炎患者白内障手术后CME的发生率和进展，并将其与葡萄膜炎类型和其他已知危险因素联系起来。2)利用oct比较有无葡萄膜炎患者白内障术后CME的发生率或进展情况。方法：研究参与者为常规白内障手术的葡萄膜炎患者和无葡萄膜炎患者（对照组）的连续队列。每组共入组50例患者。纳入葡萄膜炎组的患者有非感染性慢性葡萄膜炎（持续时间超过3个月）或复发性葡萄膜炎（2次或以上发作，间隔至少3个月），涉及眼的一个或多个节段（前、中、后）。没有既往葡萄膜炎史的患者符合纳入对照组的条件。两组均排除糖尿病或其他视网膜病变影响黄斑厚度的受试者。对于每只研究眼，OCT测试在手术前不超过4周，手术后1个月和手术后3个月进行。临床检查包括最佳矫正视力、眼部炎症和眼底检查，记录术前、术后1个月和3个月的复诊。记录每只研究眼的患者特征，包括年龄、性别、种族、葡萄膜炎的类型和持续时间、既往眼部病史和病史、药物使用、围手术期皮质类固醇和其他免疫抑制剂的使用、手术类型和并发症。Fisher精确测试将用于分析葡萄膜炎组和对照组中在1个月和3个月发生CME的参与者的比例。次要结果，如中央凹厚度和视力的平均变化将使用Wilcoxon检验在组间进行比较。回归模型将用于调查CME发病率与相关危险因素（如葡萄膜炎持续时间、黄斑水肿病史和葡萄膜炎的解剖位置）之间的统计关联。结果：结果不可得。结论：从本研究中获得的信息可能使我们能够将白内障术后CME的发病率和进展与葡萄膜炎类型和其他危险因素联系起来。我们希望这项研究能为高危患者白内障手术后CME的早期治疗和针对性预防提供信息。

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.