Pseudophakic Macular Edema in Primary Open-Angle Glaucoma: A Prospective Study Using Spectral-Domain Optical Coherence Tomography

Purpose To determine the incidence of and risk factors for pseudophakic macular edema (PME) after uncomplicated cataract surgery in primary open-angle glaucoma (POAG) using spectral-domain optical coherence tomography (SDOCT). Design Cohort study. Methods Macular retinal thickness was evaluated using SDOCT at 1 week before surgery and at 1, 3, 6, and 12 months postoperatively, in 70 POAG and 68 control eyes. Forty-three healthy subjects without impaired vision or cystoid PME were recruited separately as pilot samples to define significant PME. Significant PME was defined as an increase in the average thickness exceeding the mean + 3 standard deviations of the increase shown in the pilot samples. Results Significant PME (increase in the foveal 3-mm zone thickness of >19.5 μm) was observed in 31 (44%) eyes with POAG and in 14 (21%) control eyes (P = .003). The extent of PME was maximal at 3 months postoperatively and decreased gradually until 12 months. Regression tree analysis revealed that the risk of PME was the greatest in the POAG group using prostaglandin analogue (PGA) (odds ratio [OR] = 5.51), followed by POAG not using PGA (OR = 1.70), and control group (OR = 1.0). Risk factors for PME were younger age in all groups (OR = 1.07), systemic hypertension in PGA users (OR = 6.42), higher untreated IOP in PGA nonusers (OR = 1.09) and male sex (OR = 14.06) and diabetes mellitus (OR = 16.71) in the control group. Conclusions The incidence of PME as observed by SDOCT was higher than previously reported after uncomplicated cataract surgery. Eyes with POAG were at greater risk for PME, which was mainly associated with perioperative PGA use.