Incidence of Visually Significant Pseudophakic Macular Edema after Uneventful Clear Corneal Phacoemulsification

Abstract

Background: Pseudophakic macular edema (PME) is a known cause of delayed visual recovery following cataract surgery, even in cases with uneventful phacoemulsification. This study aimed to determine the incidence of visually significant PME in a low-risk population using optical coherence tomography (OCT).

Methods: This prospective observational study was conducted in the Department of Ophthalmology at Dr. Sirajul Islam Medical College & Hospital Ltd, Dhaka and Bangladesh Eye Hospital Malibagh, Dhaka, Bangladesh, from March 2023 to February 2024. A total of 130 patients aged ≥50 years undergoing uneventful clear corneal phacoemulsification with posterior chamber intraocular lens (IOL) implantation were enrolled consecutively. Patients with pre-existing macular disease, diabetic retinopathy, glaucoma, uveitis, or intraoperative complications were excluded. Postoperative follow-up was conducted up to 6 weeks, and OCT was used to detect PME. Visually significant PME was defined as a reduction of ≥2 lines in best-corrected visual acuity (BCVA).

Results: The mean age of participants was 62.4 ± 8.9 years, with 54.6% males. Diabetes mellitus and hypertension were present in 21.5% and 30.8% of patients, respectively. OCT detected PME in 6 patients (4.6%), of which 3 (2.3%) were visually significant. Mean BCVA improved from 0.82 ± 0.21 logMAR preoperatively to 0.16 ± 0.11 logMAR at 6 weeks. PME cases showed delayed visual recovery. All PME cases were managed with topical corticosteroids and NSAIDs; five fully recovered and one had partial improvement.

Conclusion: The incidence of visually significant PME following uncomplicated phacoemulsification was 2.3%. Early OCT detection and conservative treatment resulted in favorable outcomes.