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Combined Ab Interno Glaucoma Surgery Does not Increase the Risk of Pseudophakic Cystoid Macular Edema in Uncomplicated Eyes

Schaub, Friederike MD; Adler, Werner PhD; Koenig, Meike C. MD; Enders, Philip MD; Dietlein, Thomas S. MD; Cursiefen, Claus MD; Heindl, Ludwig M. MD

doi: 10.1097/IJG.0000000000000586
Original Studies

Purpose: To assess the risk of pseudophakic cystoid macular edema (PCME) following cataract surgery (bimanual phacoemulsification with posterior chamber lens implantation) combined with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) compared with solely cataract extraction.

Patients and Methods: In total, 360 consecutive eyes of 180 patients with age-related cataract, and thereof 162 with coexistent glaucoma, who underwent sole cataract surgery or in combination with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) were compared retrospectively regarding PCME development. Patients with known risk factors of PCME were excluded. Macular examination was performed using spectral-domain optical coherence tomography before and at 4, 8, 12, 16, 24, 36, and 48 weeks after surgery. Main outcome measure was the incidence of PCME.

Results: In total, 126 eyes (35%) underwent cataract surgery combined with ab interno glaucoma surgery (96 trabecular aspiration (76.2%), 30 ab interno trabeculotomy (23.8%), and 234 eyes (65%) received cataract surgery alone. PCME overall occurred in 23 eyes (6.4%). Following combined trabecular aspiration 5 eyes (5.2%) developed PCME, following ab interno trabeculotomy 2 eyes (6.7%), and following sole cataract surgery 16 eyes (6.8%), reaching no significant difference (P=0.676). Risk of PCME in fellow eye was significantly increased (P=0.025; odds ratio 7.177; 95% confidence interval, 5.667-8.687).

Conclusions: Additional ab interno glaucoma surgery combined with phacoemulsification does not seem to increase the risk of PCME in uncomplicated eyes. However, in patients with history of PCME a significantly increased risk of PCME in fellow eye should be taken into account.

*Department of Ophthalmology, University of Cologne, Cologne

Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany

Supported by German Research Foundation FOR 2240 “(Lymph) Angiogenesis And Cellular Immunity In Inflammatory Diseases Of The Eye” to C.C. and L.M.H., GEROK Program University of Cologne to L.M.H., Dr. Gabriele Lederle-Foundation, Taufkirchen to L.M.H., FP7 STRONG to C.C. and EU COST BM1302 “Joining Forces in Corneal Regeneration” to C.C.

Disclosure: The authors declare no conflict of interest.

Reprints: Friederike Schaub, MD, Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany (e-mail:

Received March 6, 2016

Accepted October 17, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.