title: Combined Ab Interno Glaucoma Surgery Does not Increase the Risk of Pseudophakic Cystoid Macular Edema in Uncomplicated Eyes.
abstract: OBJECTIVE
  To assess the risk of pseudophakic cystoid macular edema (PCME) following cataract surgery (bimanual phacoemulsification with posterior chamber lens implantation) combined with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) compared with solely cataract extraction.
  
  
  METHODS
  In total, 360 consecutive eyes of 180 patients with age-related cataract, and thereof 162 with coexistent glaucoma, who underwent sole cataract surgery or in combination with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) were compared retrospectively regarding PCME development. Patients with known risk factors of PCME were excluded. Macular examination was performed using spectral-domain optical coherence tomography before and at 4, 8, 12, 16, 24, 36, and 48 weeks after surgery. Main outcome measure was the incidence of PCME.
  
  
  RESULTS
  In total, 126 eyes (35%) underwent cataract surgery combined with ab interno glaucoma surgery (96 trabecular aspiration (76.2%), 30 ab interno trabeculotomy (23.8%), and 234 eyes (65%) received cataract surgery alone. PCME overall occurred in 23 eyes (6.4%). Following combined trabecular aspiration 5 eyes (5.2%) developed PCME, following ab interno trabeculotomy 2 eyes (6.7%), and following sole cataract surgery 16 eyes (6.8%), reaching no significant difference (P=0.676). Risk of PCME in fellow eye was significantly increased (P=0.025; odds ratio 7.177; 95% confidence interval, 5.667-8.687).
  
  
  CONCLUSIONS
  Additional ab interno glaucoma surgery combined with phacoemulsification does not seem to increase the risk of PCME in uncomplicated eyes. However, in patients with history of PCME a significantly increased risk of PCME in fellow eye should be taken into account.
authors.affiliation: *Department of Ophthalmology, University of Cologne, Cologne †Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Schaub
authors.forename: Werner
authors.initials: W
authors.lastname: Adler
authors.forename: Meike C
authors.initials: MC
authors.lastname: Koenig
authors.forename: Philip
authors.initials: P
authors.lastname: Enders
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Dietlein
authors.forename: Claus
authors.initials: C
authors.lastname: Cursiefen
authors.forename: Ludwig M
authors.initials: LM
authors.lastname: Heindl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications*; D005260:Female; D005901:Glaucoma / Q000150:complications / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure; D019654:Lens Implantation, Intraocular / Q000009:adverse effects; D008269:Macular Edema / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D019591:Pseudophakia / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014130:Trabeculectomy / Q000009:adverse effects / Q000379:methods*