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Visually Significant Cystoid Macula Edema After Glaucoma Drainage Implant Surgery

Bhakta, Amitabha, S., PhD*; Fortun, Jorge, MD*; Thomas, Julien, MSc; Greer, Anthony, MD; Kishor, Krishna, MD*; Maharaj, Arindel, MD, PhD*

doi: 10.1097/IJG.0000000000000855
Original Studies

Purpose: This study examines the incidence of visually significant cystoid macular edema (CME) after glaucoma drainage implant (GDI) surgery and analyses risk factors associated with developing CME and prognosis with treatment.

Materials and Methods: In total, 185 eyes from 185 glaucoma patients (mean age, 72.46±13.94 y) who underwent GDI surgery at a tertiary eye institute were recruited. Patients were classified based on the presence (CME) or absence (No-CME) of CME. Pre-GDI and post-GDI best-corrected visual acuity, number of intraocular pressure (IOP)-lowering medications, IOP, standard automated perimetry and post-GDI complications, were recorded and compared between the 2 groups. Optical coherence tomography (OCT) was used to quantify retinal thickness and monitor CME.

Results: In total, 41 (22.2%) eyes developed visually significant CME after GDI surgery. Patients with CME had a higher incidence of pre-GDI nonsteroidal anti-inflammatory drug (P<0.01) use and higher number of prior glaucoma surgeries (P<0.01). CME patients had a higher (P<0.01) incidence of iritis, epiretinal membrane, and hypotony. CME eyes responded well to steroids, with resolving macular edema (458.4±151.9 vs. 322.0±92.0 µm, P<0.01) and improving visual acuity (0.73±0.48 vs. 0.56±0.56 logarithm of minimum angle of resolution, P<0.01). Both CME and non-CME groups had equivalent lowering of IOP and post-GDI glaucoma medications; with no significant elevation in IOP in the steroid-treated CME group.

Conclusions: Post-GDI surgery visually significant CME rates are potentially higher in a real hospital scenario compared with controlled clinical trials. With diligent treatment, CME resolves effectively restoring visual acuity and central macular thickness.

*Bascom Palmer Eye Institute, University of Miami, Palm Beach

Miller School of Medicine, University of Miami, Miami, FL

Looking Glass Eye Center, Brevard, NC

Supported by NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant.

Disclosure: The authors declare no conflict of interest.

Reprints: Arindel Maharaj, MD, PhD, Bascom Palmer Eye Institute, University of Miami, 7101 Fairway Avenue, Palm Beach Gardens, FL 33418 (e-mail:

Received June 23, 2017

Accepted December 11, 2017

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.