Title : Predictors of chronic pseudophakic cystoid macular edema
Abstract:
Purpose: To identify how OCT biomarkers and visual acuity may predict chronic pseudophakic cystoid macular edema (pCME).
Setting: Tennent Institute of Ophthalmology, Glasgow, United Kingdom. (Public Hospital)
Design: A retrospective analysis of patients referred with pCME at Greater Glasgow and Clyde National Health Service (NHS GG&C) between January 2021 and December 2023.
Method: Referrals identified from the NHS GG&C cataract audit database. Electronic patient records and SD-OCT scans were independently reviewed by two ophthalmologists. Pre-operative or non-pseudophakic CME were excluded. Data collected included demographic details, LogMAR visual acuity, OCT derived central retinal thickness (CRT) and choroidal thickness. Spearman correlation and multivariate logistic regression identified predictors of chronic pCME.
Result: Of 245 eyes referred with CME after phacoemulsification, 160 eyes met inclusion criteria for pCME; 44 (27.5%) developed chronic pCME (≥90 days). Thicker choroid (Spearman correlation coefficient (r) =0.263, p=0.0015) and CRT ( r =0.580, p<0.001) at diagnosis correlated with increased CME duration. Worse LogMAR visual acuity correlated with chronicity (r=-0.291, p=0.0005). Multivariate logistic regression identified greater choroidal thickness (OR 1.0072, 95% CI 1.0022–1.0121) and higher CRT (OR 1.0090, 95% CI 1.0047–1.0133) as independent predictors of chronic pCME.
Conclusion: Higher CRT and greater choroidal thickness at diagnosis of CME significantly increased the predicted probability of developing chronic pCME. Visual acuity was not predictive. Our findings support the hypothesis that greater central retinal and choroidal thickness at presentation confers a higher risk of chronicity. The proposed predictive model combining CRT and choroidal thickness offers a novel approach to early risk stratification in pCME, potentially guiding counselling and management.
