ATARACT POSTOPERATIVE COMPLICATIONS Before performing surgery — or stunts — assessing risks is crucial.
Experts’ Take
On Preventing CME after Lens-Based Surgery by Joanna Lee
O
ver the years, sight-threatening postoperative cataract surgery complications like cystoid macular edema (CME) and endophthalmitis have been minimized. This is largely due to the efficacy of topical nonsteroidal anti-inflammatory drugs (NSAIDs), which help manage intra- and postoperative inflammation. Robust evidence has shown that these medications, along with precise surgical skills and practical measures, have helped doctors mitigate the risk factors that allow these conditions to develop.1
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Look out for High-Risk Patients
To minimize the chances of developing postoperative CME, assessing the risk factors is a critical first step. According to Dr. Alay Banker from Banker’s Retina Clinic and Laser Centre in Ahmedabad, India, patients with pre-existing conditions (like diabetes and uveitis) would be susceptible to CME.
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“If they have any co-existing ocular conditions such as uveitis, diabetic macular edema (DME), or retinal vascular conditions, doctors should make sure the patient is disease-free before cataract surger, or their blood sugar level should be absolutely under control for at least three months prior to cataract surgery,” he shared. There is evidence to support this concern over diabetics, according to Dr. Mae-Lynn Bastion from the National University of Malaysia Hospital. She cited a retrospective study of 82,000 eyes which quantified how patients face an ascending risk of postcataract surgery CME as their diabetic retinopathy progresses.2 Additionally, she said: “There is a subtle difference between a patient with CME and the ones with DME.” To discern between the two, Dr. Bastion said CME cases would show cystoid changes, while DME patients would have hard exudation and subretinal fluids.
| May 2020
Besides those with diabetes and uveitis, patients who previously had a posterior capsular tear during surgery are also at risk. “Postoperatively, if there is prolonged persistent inflammation and if near vision or if reading vision doesn’t improve, I would order a macular optical coherence tomography (OCT),” explained Dr. Bastion. “Certain drugs, such as those from the prostaglandin analog (PGA) group do have side effects, which can add to the risk. So, I usually would avoid them after surgery, especially if the capsular bag is compromised,” she added. Ensuring that eyelids are free from blepharitis and other conditions is also imperative to minimize the risk of CME or endophthalmitis.3
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Utilize NSAID Eye Drops for CME Prevention
Consultant ophthalmologist and eye surgeon Dr. Yee Fong Choong, from the International Specialist Eye Centre
