Latz Catharina, Licht Annika, Bayati Peyman, Taya Kazem, Mirshahi Alireza
Dardenne Eye Hospital, Bonn, Germany.
Graefes Arch Clin Exp Ophthalmol. 2025 Mar;263(3):829-835. doi: 10.1007/s00417-024-06663-y. Epub 2024 Oct 15.
This study aimed to evaluate the occurrence of pseudophakic cystoid macular edema (PCME) post low-energy femtosecond laser-assisted cataract surgery (FLACS) in a high-volume surgical setting.
The medical records of 242 FLACS patients were retrospectively reviewed. The central subfield macular thickness (CSMT) was measured via optical coherence tomography (OCT) before and 4-6 weeks after surgery, and the results were compared for PCME detection. Macular edema was defined as a 10% increase in CSMT, a new onset of intraretinal fluid, or a decrease in visual acuity (VA). VA development in PCME patients was reviewed at 2-3 months and 6 months.
The median patient age was 72 years (49-92 years). Among 242 eyes, seven eyes (2.89%) developed PCME. The median preoperative CSMT in these eyes was 255 μm (minimum 231 μm, maximum 326 μm), whereas the median CSMT at 4-6 weeks after surgery was 317 μm (minimum 255 μm, maximum 463 μm). 4- to 6-week postoperative visual acuity decreased in comparison with 1-week postoperative values in three eyes of two patients, remained stable in two patients, and improved in one patient, whereas one patient did not return for his 1-week appointment but improved from 0.4 to 0.2 logMAR 2.5 months postoperatively. By 3-6 months, all eyes with PCME had gained visual acuity in comparison with their preoperative values. None of the PCME patients had diabetes or used prostaglandin analogues. Three patients were receiving anticoagulation medication.
A 2.89% incidence of PCME after low-energy FLACS matched published standard phacoemulsification rates. In our series of uncomplicated cases, PCME caused only a transient postoperative decrease in visual acuity.
What is known Increased prostaglandin levels have been detected in the aqueous humour of cataract patients after femtosecond laser application. Prostaglandins are mediators of inflammation. Femtosecond lasers come in low energy and high energy variants. There is contrasting evidence of increased incidence of PCME after femtosecond laser assisted cataract surgery (FLACS) What is new The incidence of PCME after low-energy FLACS in our high volume surgical setting is 2.89% Low-energy FLACS does not seem to have a causative effect on PCME.
本研究旨在评估在大量手术病例中，低能量飞秒激光辅助白内障手术（FLACS）后假性囊膜性黄斑水肿（PCME）的发生率。
回顾性分析242例接受FLACS手术患者的病历。术前及术后4 - 6周通过光学相干断层扫描（OCT）测量黄斑中心子区域厚度（CSMT），并比较结果以检测PCME。黄斑水肿定义为CSMT增加10%、视网膜内液新出现或视力（VA）下降。对发生PCME患者在术后2 - 3个月和6个月时的视力变化进行评估。
患者年龄中位数为72岁（49 - 92岁）。在242只眼中，7只眼（2.89%）发生了PCME。这些眼中术前CSMT中位数为255μm（最小值231μm，最大值326μm），而术后4 - 6周CSMT中位数为317μm（最小值255μm，最大值463μm）。与术后1周相比，两名患者的三只眼术后4 - 6周视力下降，两名患者视力保持稳定，一名患者视力提高，而一名患者未返回术后1周的预约检查，但术后2.5个月时视力从0.4提高到了0.2 logMAR。到3 - 6个月时，所有发生PCME的眼与术前相比视力均有提高。发生PCME的患者均无糖尿病，也未使用前列腺素类似物。三名患者正在接受抗凝治疗。
低能量FLACS术后PCME发生率为2.89%，与已发表的标准超声乳化手术发生率相符。在我们这一系列无并发症的病例中，PCME仅导致术后视力短暂下降。
已知情况 在应用飞秒激光后，白内障患者房水中检测到前列腺素水平升高。前列腺素是炎症介质。飞秒激光有低能量和高能量两种类型。关于飞秒激光辅助白内障手术（FLACS）后PCME发生率增加存在相互矛盾的证据 新发现 在我们大量手术病例中，低能量FLACS术后PCME发生率为2.89% 低能量FLACS似乎对PCME没有致病作用
