Postoperative Macular Edema Risk Higher in Patients with RVO History

Findings from a recent study suggest eyes with retinal vein occlusion (RVO) with previous cystoid macular edema (CME) requiring intravitreal treatment are at substantial risk of postoperative macular edema (PME) after uneventful cataract surgery. Of note, this risk increases significantly in patients with diabetes.1

Although PME rates have largely been reduced due to modern phacoemulsification techniques, patients with diabetes still have a substantial risk of developing postoperative enema, as well as the greatest challenges in terms of treatment and prophylaxis. Patients fitting these criteria tend to have been excluded from existing studies of postoperative PME.2

“Patients with RVO need to be counseled carefully regarding outcomes of cataract surgery; also, the outcomes might depend on the previous treatment course they have received, and they may need to undergo a repeat cycle of treatment due to a risk of return of macular edema,” wrote Sagnik Sen, MD, MRCSEd, Department of Retina and Vitreous, Aravind Eye Hospital, and colleagues.1

The retrospective chart review was conducted in a tertiary care center in South India and included patients with RVO undergoing cataract surgery between 2015 and 2019. All patients with previous RVO diagnoses in the operative eye, with or without a history of preoperative macular edema, were included in the study.1

Patients with anti-VEGF injections within the last 30 days, complicated cataract surgery, posterior capsular rupture, use of glaucoma medicine, vitrectomy history, diabetic retinopathy, age-related macular degeneration, or previous history of Ozurdex injection were excluded.1

Of the 162 patients included in the study, 72 had a history of diabetes mellitus, 112 had hypertension, 31 had ischemic heart disease (IHD), and 20 had hyperlipidemia. Mean age of participants was 66.4 +/- 9.3 years, with 92 male and 72 female patients.1

Among the cohort, 119 had branch RVO (BRVO) and 43 had central RVO (CRVO). Of the latter, 35 had ischemic and 8 had non-ischemic CRVO. A total of 137 patients presented RVO more than 6 months from cataract surgery and 25 within the last 6 months.1

All patients underwent phacoemulsification or manual small incision cataract surgery (mSICS), after which they received routine postoperative regimen of topical steroid-antibiotic combinations which were tapered weekly over the course of 1 month.1

Follow-ups occurred on postoperative day 1 and at 1 month, after which additional follow-ups were conducted at the surgeon’s discretion. Patients experiencing diminution of visual acuity (VA) were given an optical coherence tomography (OCT) scan. The team collected VA at baseline, postoperative 1 month, and at final follow-up.1

Sen and colleagues followed up with patients for an average duration of 13 +/- 10.9 months after surgery. They found that postoperative macular edema had occurred within 3 months for 40.1% of all eyes, 21% of eyes without previous CME, 57.3% of eyes with previous CME, and in 50% of patients with diabetes. Further analysis revealed diabetes (odds ratio [OR], 2.1; 95% CI, 1.10-3.98; P = .023), preoperative CME (OR, 4.62; 95% CI, 2.33-9.15; P <.0001), and preoperative CME requiring anti-VEGF treatment (OR, 4.83; 95% CI, 2.43-9.59; P <.0001) were significant risk factors.1

Visual acuity of operated eyes improved significantly from 0.85 +/- 0.55 logMAR at baseline to 0.365 +/- 0.39 logMAR (P <.0001) at the final follow-up. However, eyes with postoperative macular edema had an increased chance of poorer vision gains (worse than 6/18).1

Investigators noted that this study demonstrated that RVO eyes with a history of CME treatment exhibit a substantial risk of postoperative macular edema after uneventful cardiac surgery. Given that almost 2/3 of PME developed within the first month of surgery, Sen and colleagues suggested that eyes at risk undergo regular OCT scans as part of the postoperative assessment after the first visit post-surgery.1

“Apart from CRVO, patients with DM, eyes with previous history of edema and injection also had poorer final outcome,” wrote Sen and colleagues. “This suggests that special attention needs to be given to diabetic eyes and eyes with previous history of CME which have received injections in the past, during, and after cataract surgery.”1

References

1. Sen S, Damodaran S, Udaya P, et al. Risk factors and incidence of macular edema in eyes with retinal vein occlusion after uneventful cataract surgery: The Mevo Study. Indian Journal of Ophthalmology. Published online April 17, 2025. doi:10.4103/ijo.ijo_1700_24

2. Chu CJ, Johnston RL, Buscombe C, Sallam AB, Mohamed Q, Yang YC. Risk factors and incidence of macular edema after cataract surgery. Ophthalmology. 2015;123(2):316-323. doi:10.1016/j.ophtha.2015.10.001