Researchers from Spain recommend practitioners perform spectral-domain optical coherence tomography (SD-OCT) before cataract surgery because fundus examination might not detect an epiretinal membrane. In their study, the membrane’s presence in the macular area with no foveal alterations was the only risk factor for pseudophakic cystoid macular edema (CME) and may implicate a previous subclinical damage or increased predisposition to both conditions.

In a prospective cohort study, 112 patients underwent SD-OCT within one week pre-op and three months post-op. CME incidence in the cohort was 11.6% (13 eyes), all of which were diagnosed at one month, and seven eyes resolved at three months. The study did not find a significant association between CME and other variables such as posterior vitreous detachment, subfoveal choroidal thickness, diabetes or hypertension. Researchers believe that this may indicate that other factors besides status of the vitreoretinal interface may influence the development of cystoid macular edema.

The study advocates pretreatment with a topical nonsteroidal anti-inflammatory drug for patients with epiretinal membrane on preoperative OCT scans and concludes that further research needs to confirm the impact of vitreoretinal interface abnormalities on postsurgical macular edema development.

Copete S, Martí-Rodrigo P, Muñez-Vidal R, et al. Preoperative vitreoretinal interface abnormalities on spectral domain optical coherence tomography as risk factor for pseudophakic cystoid macular edema after phacoemulsification. Retina. August 28, 2018. [Epub ahead of print].