Macular edema after cataract surgery in eyes with and without pseudoexfoliation syndrome

Background: The purpose of the study was to identify macular edema after cataract surgery in eyes with and without pseudoexfoliation syndrome. The study was a post-hoc analysis of a randomized, double-blind, prospective single-center study. Patients were enrolled between January 2016 and October 2016 as per the national guidelines for the management of cataract in the Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland. Methods: One hundred and fifty-six eyes of 149 patients undergoing routine cataract surgery. Postoperatively anti-inflammatory medication was either dexamethasone (N = 78) or diclofenac (N = 78). Spectral domain optical coherence tomography imaging and laser flare meter measurement of the anterior chamber were conducted before surgery and at the control visit 28 days postoperatively. Results: Baseline variables were comparable between eyes with pseudoexfoliation syndrome (N = 32) and those without (N = 124), except for intraocular pressure (P = 0.002) and glaucoma medication (P < 0.001). In patients having pseudoexfoliation syndrome, central retinal thickness increase (mean +/- standard error of the mean) was 63.3 +/- 35.5 mu m for dexamethasone and 17.6 +/- 5.8 mu m for diclofenac, compared to 28.9 +/- 8.0 mu m (P = NS) and 6.9 +/- 1.3 mu m (P = 0.014) in eyes without pseudoexfoliation syndrome, respectively. Aqueous flare at 28 days was 25.8 +/- 5.4 pu/ms for patients with pseudoexfoliation syndrome and 18.3 +/- 1.8 pu/ms for those without (P = 0.030). Best corrected visual acuity gain and best corrected visual acuity at 28 days were less in patients having pseudoexfoliation syndrome compared to those without (0.39 +/- 0.07 vs 0.59 +/- 0.03 decimals, P = 0.007; and 0.77 +/- 0.06 vs 0.92 +/- 0.03 decimals, P = 0.008, respectively). Conclusion: Eyes with pseudoexfoliation syndrome may be predisposed to an increased aqueous flare and macular edema after cataract surgery. This study outlines the need to determine the optimal anti-inflammatory medication after cataract surgery in patients with pseudoexfoliation syndrome.