Research Digest

FAF with OCT useful in post-phaco CME

Cystoid macular edema is a troublesome complication in some cases of phacoemulsification, but it can be difficult to detect, particularly when it does not cause changes in postoperative visual acuity.

To test the ability of fundus autofluorescence (FAF) and OCT in detecting post-phaco CME, doctors in Turkey evaluated 40 eyes of 29 patients who received phaco and posterior-chamber IOLs. They took measurements on day one postoperatively and then monthly afterward. They detected hyperautofluorescence, indicating CME, in three eyes of two patients.

Further, these eyes experienced increasing central macular thickness over six months. The authors concluded FAF, when used with OCT, can be a useful noninvasive adjunct in the diagnosis of post-phaco CME.

REFERENCE: Sahin M, Cingü AK, Gözüm N. Evaluation of cystoid macular edema using optical coherence tomography and fundus autofluorescence after uncomplicated phacoemulsification surgery. J Ophthalmol. 2013;376013.

Aqueous flare values and post-phaco CME.

Meanwhile, in Germany, ophthalmologists have identified aqueous flare as a marker for inflammation and breakdown of the blood-retinal barrier in patients with post-phaco CME.

Examining 30 eyes of 30 patients with clinically significant post-phaco CME and vision loss, the authors measured retinal thickness. In addition, they used the Kowa FM-500 Laser Flare-cell Meter (Nagoya, Japan) to measure aqueous flare quantitatively.

Not only did the patients have significantly higher aqueous flare values than pseudophakic controls, but the authors also found that the flare values were correlated with BCVA. There was no such correlation with retinal thickness.

The authors concluded that aqueous flare values can be used to predict post-phaco CME with 97.6% accuracy.

REFERENCE: Ersoy L, Caramoy A, Ristau T, Kirchhof B, Fauser S. Aqueous flare is increased in patients with clinically significant cystoid macular oedema after cataract surgery. Br J Ophthalmol. 2013 Apr 23. [Epub ahead of print]

Long-term thinning after pediatric phaco

To evaluate the long-effects on the corneal endothelium of pediatric cataract surgery patients, surgeons in Spain undertook a cross-sectional study of 58 eyes operated on for pediatric cataracts at a mean age of 38.2 months.

The authors collected data on endothelial cell density, hexagonal cell percentage, and cell area. Because all cases were unilateral, the authors compared the outcomes with data from the fellow eyes.

After a mean follow-up of 14½ years, the authors found an average loss of 9.2% of endothelial cell density in the operated eyes. The outcome was highly statistically significant (P > 0.000). The study authors detected no statistically significant changes with regard to the other data.

Although prospective data would be more reliable, the study offers strong evidence of a long-term thinning effect on the corneal endothelium.

REFERENCE: Borghol Kassar R, Menezo Rozalén JL, Harto Castaño MÁ, Desco Esteban MC. Long-term follow-up of the corneal endothelium after pediatric cataract surgery. Cornea. 2013;32:529-532.

Cyclosporine for post-phaco dry eye

Dry eye is a common complication of phaco. Given cyclosporine’s usefulness in dry eye, doctors in South Korea tested twice-daily treatment with cyclosporine 0.05% for post-phaco dry eye.

They enrolled 32 patients one week after cataract surgery. Each patient received cyclosporine drops in one eye and 0.9% saline in the other. The doctors submitted the patients to Schirmer and tear-film-breakup testing and obtained corneal temperatures at two weeks, one month, two months and three months. The patients also completed the Ocular Surface Disease Index questionnaire.

Schirmer testing revealed more rapid recovery in the cyclosporine group. Tear film breakup also improved in treated eyes at two and three months. Finally, the authors detected significant improvements in questionnaire scores in the cyclosporine group.

The study offered evidence for the use of cyclosporine for DED of more than one etiology. The study authors stated it could be a useful adjunct in phaco cases.

REFERENCE: Chung YW, Oh TH, Chung SK. The effect of topical cyclosporine 0.05% on dry eye after cataract surgery. Korean J Ophthalmol. 2013;27:167-171.

Glaucoma after congenital cataract removal

Ophthalmologists at Emory University in Atlanta estimated that nearly two-thirds of eyes undergoing removal of congenital cataracts will either develop glaucoma or become suspected of having the disease within 10 years.

In a retrospective, interventional, consecutive case series, the authors reviewed the records of 62 eyes of 37 children, all of whom underwent surgery before the age of 7 months. The same surgeon used a limbal approach in all of the cases.

Nine eyes developed glaucoma at a median of 4.3 months, with another 16 eyes suspected of being glaucomatous at a median of 8 years. Combining the risks of glaucoma and glaucoma suspicion, the authors found a 63% risk by 10 years post-phaco.

The authors urged long-term monitoring of these eyes for earlier detection of glaucoma symptoms. Sufficiently early diagnosis can delay the onset of the disease. OM

REFERENCE: Lambert SR, Purohit A, Superak HM, Lynn MJ, Beck AD. Long-term risk of glaucoma after congenital cataract surgery. Am J Ophthalmol. 2013 Apr 30. [Epub ahead of print]