Those who have pseudophakic cystoid macular edema in one eye have a 10.7% risk of developing the condition in the fellow eye, compared with a 0.9% risk without first-eye involvement. Photo: Oliver Kuhn-Wilken, OD. Click image to enlarge.

A common complication of cataract surgery, pseudophakic cystoid macular edema (CME) is often addressed prophylactically in high-risk patients using NSAIDs or periocular steroid injections. Recently, researchers investigated the risk of developing CME in fellow-eye cataract surgery and reported that first-eye CME was a strong independent risk factor.

The retrospective study included 54,209 patients (mean age: 74.6 years, 38.8% male). The researchers reported that 1% of patients developed CME in the fellow eye. They found a 0.9% risk for fellow-eye CME in those without first-eye CME and a risk of 10.7% in those with first-eye CME.

Risk factors for fellow-eye CME based on the researchers’ fully adjusted model included first-eye CME [risk ratio (RR): 8.55], epiretinal membrane (RR: 4.1), history of retinal vein occlusion (RR: 2.94), diabetes without history of diabetic macular edema (RR: 2.08), advanced cataract (RR: 1.75), preoperative prostaglandin analogue use (RR: 1.49) and male sex (RR: 1.19).

The researchers concluded in their paper that first-eye CME results in an independent eight-fold increase in the risk for fellow-eye CME. “While clinicians have been anecdotally aware of this increased risk, our findings add objective data and provide useful numbers when counseling patients undergoing fellow-eye cataract surgery,” they wrote in their paper. They also noted that these findings may “help in identifying high-risk patients who may benefit from prophylactic therapy.”

Shakarchi AF, Soliman MK, Yang YC, et al. Risk of pseudophakic cystoid macular edema in fellow-eye cataract studies: a multicenter database study. Ophthalmology. February 3, 2023. [Epub ahead of print].