Posters

Database study of 20,066 cataract operations: do intraoperative subconjunctival steroids reduce the rate of macular oedema following cataract surgery?

Poster Details

First Author: M.Teo UK

Co Author(s):    P. Ursell   R. Muniraju                 

Abstract Details

Purpose:

To assess if intra-operative subconjunctival steroids have an effect on incidence of post-operative macular oedema in (a) normal (non-diabetic) patients, (b) diabetics without retinopathy and (c) diabetics with diabetic retinopathy.

Setting:

Retrospective, single-centre (Epsom and St Helier NHS Hospitals, London), database study analysing 20,066 cataract surgeries extracted from electronic patient record (EPR) ‘medisoft’ from October 2007 to November 2017.

Methods:

Data collected by EPR were extracted for each eye undergoing cataract surgery for occurrence of macular oedema within 3 months of cataract surgery, use of intraoperative subconjunctival steroids, diabetic status, intraoperative complications, post-operative complications, post-operative use of NSAIDs, co-pathologies, and concurrent anti-VEGF injection. Patients with factors that may affect rate of post-operative macular oedema were excluded. This comprised of patients with complicated surgery (PC rupture, vitreous loss, lens fragment into vitreous, iris trauma, hyphema, choroidal haemorrhage, zonular dialysis); known risk factors for macular oedema (uveitis, vitrectomy, retinal vein occlusion, and/or epiretinal membrane); concurrent anti-VEGF injection and post-operative NSAID use.

Results:

In all 3 groups, there was a relative risk reduction of post-operative macular oedema of between 30 - 40% in patients who received subconjunctival steroids.16% of group(b) and 42% of group(c) were on NSAIDs post-operatively, therefore were excluded from the study. Consequently, in these groups, the reduction in incidence of macular oedema did not reach statistical significance of p <0.05, but all groups reached a significance of p≤ 0.1. There was no increase in rate of raised IOP. (a) Non-diabetics n= 13000 (0.55%vs0.84% ,RRR=0.34,p=0.034) (b)Diabetics without retinopathy n= 2862 (0.91%vs1.52%,RRR=0.40,p=0.100) (c)Diabetics with retinopathy n= 644 (8.19%vs11.62%,RRR=0.30,p=0.098)

Conclusions:

There appeared to be a trend towards a lower incidence of post-operative macular oedema with the use of subconjunctival steroids, which reached statistical significance of P<0.05 in group (a). A large proportion of diabetic patients had to be excluded from the study due to post-operative NSAID use. This study supports further evaluation of the use of subconjunctival steroids in cataract surgery, controlling for NSAID use.

Financial Disclosure:

None