title: Improving visual outcomes by preserving outer retina morphology in eyes with resolved pseudophakic cystoid macular edema.
abstract: OBJECTIVE
  To use ultra-high-resolution optical coherence tomography (OCT) subclinical anatomic alterations to explain suboptimum vision despite pseudophakic cystoid macula edema (CME) resolution.
  
  
  METHODS
  University of California-Davis, Sacramento, California, USA.
  
  
  METHODS
  Case study.
  
  
  METHODS
  This study comprised patients who had cataract phacoemulsification surgery. Cases of resolved postoperative CME (diagnosed postoperatively by 1 month and resolved by 1 year) were included. Exclusion criteria included any other cause for decreased vision or compounding factors. Patients with a history of resolved pseudophakic CME were imaged using a purpose-built ultra-high-resolution OCT system with 4.5 μm axial resolution and an acquisition speed of 9 frames/sec (1000 A-scans/frame). The corrected distance visual acuity (CDVA) was determined by Early Treatment Diabetic Retinopathy Study standards. Statistical analysis was by the unpaired t test. A P value less than 0.05 was considered significant.
  
  
  RESULTS
  The review identified 56 patients with a pseudophakic CME diagnosis at least 1 month postoperatively. Fifteen eyes (26.8%) had less than 20/20 CDVA despite resolution of CME; 7 participated. Four patients with 20/20 CDVA after resolution of pseudophakic CME participated. Eyes with reduced CDVA after macula edema showed ultra-high-resolution OCT evidence of blurring of outer segments of photoreceptors, while controls showed normal outer retina morphology (P<.05).
  
  
  CONCLUSIONS
  Persistent anatomic alteration of photoreceptors visualized by ultra-high-resolution OCT correlated with reduced CDVA in patients with pseudophakic CME compared with patients who had 20/20 CDVA after macula edema. This anatomic alteration in outer photoreceptor morphology is a plausible explanation for the reduced CDVA in this disease.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors: From the University of California-Davis, Sacramento, California, USA. Electronic address: hunter.allan.a@gmail.com.
authors: Allan A
authors: AA
authors: Hunter
authors: From the University of California-Davis, Sacramento, California, USA.
authors: Sara P
authors: SP
authors: Modjtahedi
authors: From the University of California-Davis, Sacramento, California, USA.
authors: Kuumba
authors: K
authors: Long
authors: From the University of California-Davis, Sacramento, California, USA.
authors: Robert
authors: R
authors: Zawadzki
authors: From the University of California-Davis, Sacramento, California, USA.
authors: Eric K
authors: EK
authors: Chin
authors: From the University of California-Davis, Sacramento, California, USA.
authors: Jeffrey J
authors: JJ
authors: Caspar
authors: From the University of California-Davis, Sacramento, California, USA.
authors: Lawrence S
authors: LS
authors: Morse
authors: From the University of California-Davis, Sacramento, California, USA.
authors: David G
authors: DG
authors: Telander
mesh_terms: D005583:Fourier Analysis; D006801:Humans; D019654:Lens Implantation, Intraocular; D008269:Macular Edema / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D018918:Phacoemulsification; D011183:Postoperative Complications; D019591:Pseudophakia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D055214:Retinal Photoreceptor Cell Outer Segment / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000175:diagnosis* / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology*