Predictive Factors and Management of Macular Edema after Retropupillary Iris-Claw Intraocular Lens Implantation in Aphakia: National Multicenter Audit-Report 2

The aim of this multicenter, national clinical audit is to evaluate the predictive factors and management of postoperative macular edema (ME) after retropupillary iris-claw intraocular lens (RICI) implantation and pars plana vitrectomy (PPV). Preoperative, surgical and postoperative data were collected. Number and type of intravitreal injections (IT) administered (anti-VEGF or dexamethasone implant), visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) assessed by OCT were collected at 1, 3, 6 and 12 months. From 325 eyes (325 patients), 11.7% (38/325) developed postoperative ME. Previous complicated cataract surgery with no capsular support was the only significant predictive factor for developing postoperative ME (OR 2.27, 95% CI 1.38-4.52, p = 0.02) after RICI implant. Mean time to ME development was 11.4 +/- 10.7 weeks, and mean CRT peaked at 3 months follow-up. Different treatment options were non-steroidal anti-inflammatory (NSAIDs) drops (31.6%, 12/38), dexamethasone (DEX) implant (50%, 19/38), anti-VEGF (7.9%, 3/38) or combined IT (10.5%, 4/38). Cumulative probability of ME resolution was higher in the group treated with IT than in the group treated with topical NSAIDs (85.2% vs. 58.3%, p = 0.9). Performing RICI implantation after complicated cataract surgery is a risk factor for the development of postoperative ME. DEX implants may be an effective treatment for postoperative ME in these cases.