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Incidence and Management of Cystoid Macular Edema after Corneal Transplantation

  • Cornea (T Yamaguchi, Section Editor)
  • Published:
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Abstract

Purpose of Review

In this review, we overview the incidence and management of cystoid macular edema following endothelial keratoplasty (EK) including Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK).

Recent Findings

Incidence of CME was 2.0–12.7% following DSAEK and 0.7–15.6% following DMEK. Glaucomatous eyes, in particular, with primary angle closure glaucoma and eyes with severe iris damage and eyes with combined EK with transscleral intraocular lens implantation experienced postoperative CME at a higher incidence. Topical non-steroidal anti-inflammatory (NSAIDs) and intensive topical steroid can effectively treat and prevent CME recurrences.

Summary

CME is one of the major complications following EK and can be involved in the limitation of the recovery of postoperative visual acuity. Careful attention should be paid to patients with systemic and ocular conditions, as these might trigger postoperative CME. The prophylactic use of NSAIDs and intensive steroid treatment may be a reasonable approach.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gass JD, Norton EW. Cystoid macular edema and papilledema following cataract extraction. A fluorescein fundoscopic and angiographic study. Arch Ophthalmol. 1966;76:646–61.

    CAS  PubMed  Google Scholar 

  2. Irvine SR. A newly defined vitreous syndrome following cataract surgery. Am J Ophthalmol. 1953;36:599–619.

    CAS  PubMed  Google Scholar 

  3. Wielders LH, Schouten JS, Aberle MR, Lambermont VA, van den Biggelaar FJ, Winkens B, et al. Treatment of cystoid macular edema after cataract surgery. J Cataract Refract Surg. 2017;43:276–84.

    PubMed  Google Scholar 

  4. Miyake K. Prevention of cystoid macular edema after lens extraction by topical indomethacin (I). A preliminary report. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1977;203:81–8.

    CAS  PubMed  Google Scholar 

  5. America EBAo. 2015 Eye Banking Statistical Report. http://restoresight.org/wp-content/uploads/2016/03/2015-Statistical-Report.pdf.

  6. Price MO, Price FW Jr. Endothelial keratoplasty - a review. Clin Exp Ophthalmol. 2010;38:128–40.

    PubMed  Google Scholar 

  7. Guerra FP, Anshu A, Price MO, Giebel AW, Price FW. Descemet’s membrane endothelial keratoplasty: prospective study of 1-year visual outcomes, graft survival, and endothelial cell loss. Ophthalmology. 2011;118:2368–73.

    PubMed  Google Scholar 

  8. Turnbull AM, Tsatsos M, Hossain PN, Anderson DF. Determinants of visual quality after endothelial keratoplasty. Surv Ophthalmol. 2016;61:257–71.

    PubMed  Google Scholar 

  9. Acar BT, Akdemir MO, Acar S. Visual acuity and endothelial cell density with respect to the graft thickness in Descemet’s stripping automated endothelial keratoplasty: one year results. Int J Ophthalmol. 2014;7:974–9.

    PubMed  PubMed Central  Google Scholar 

  10. Rudolph M, Laaser K, Bachmann BO, Cursiefen C, Epstein D, Kruse FE. Corneal higher-order aberrations after Descemet’s membrane endothelial keratoplasty. Ophthalmology. 2012;119:528–35.

    PubMed  Google Scholar 

  11. Henderson BA, Kim JY, Ament CS, Ferrufino-Ponce ZK, Grabowska A, Cremers SL. Clinical pseudophakic cystoid macular edema. Risk factors for development and duration after treatment. J Cataract Refract Surg. 2007;33:1550–8.

    PubMed  Google Scholar 

  12. Kramer SG. Cystoid macular edema after aphakic penetrating keratoplasty. Ophthalmology. 1981;88:782–7.

    CAS  PubMed  Google Scholar 

  13. Olson RJ, Waltman SR, Mattingly TP, Kaufman HE. Visual results after penetrating keratoplasty for aphakic bullous keratopathy and Fuchs' dystrophy. Am J Ophthalmol. 1979;88:1000–4.

    CAS  PubMed  Google Scholar 

  14. Wright PL, Wilkinson CP, Balyeat HD, Popham J, Reinke M. Angiographic cystoid macular edema after posterior chamber lens implantation. Arch Ophthalmol. 1988;106:740–4.

    CAS  PubMed  Google Scholar 

  15. Holekamp NM. Treatment of pseudophakic CME. Ocul Immunol Inflamm. 1998;6:121–3.

    CAS  PubMed  Google Scholar 

  16. Jaffe NS, Clayman HM, Jaffe MS. Cystoid macular edema after intracapsular and extracapsular cataract extraction with and without an intraocular lens. Ophthalmology. 1982;89:25–9.

    CAS  PubMed  Google Scholar 

  17. •• Kitazawa K, Kayukawa K, Wakimasu K, Yokota I, Inatomi T, Hieda O, et al. Cystoid macular edema after Descemet’s stripping automated endothelial Keratoplasty. Ophthalmology. 2017;124:572–3. A clicnial study indicating that glaucomatous eyes accounted for the highest incidence of CME following endothelial keratoplasty.

    PubMed  Google Scholar 

  18. Shehadeh Mashor R, Nasser O, Sansanayudh W, Rootman DS, Slomovic AR. Changes in macular thickness after Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2015;159:415–8.e1.

    PubMed  Google Scholar 

  19. • Kitazawa K, Kayukawa K, Wakimasu K, Yokota I, Inatomi T, Hieda O, et al. Predictive clinical factors of cystoid macular edema in patients with Descemet's stripping automated endothelial keratoplasty. Sci Rep. 2017;7:7412. A multivaliate analyis illustrated predictive clinical factors which may trigger CME following endothelial keratoplasty, inluding air rebubbling, combined cataract surgery, primary indication, iris damage, diabetes, uveitis and etc. as covariates.

    PubMed  PubMed Central  Google Scholar 

  20. • Yazu H, Yamaguchi T, Dogru M, Ishii N, Satake Y, Shimazaki J. Descemet-stripping automated endothelial keratoplasty in eyes with transscleral-sutured intraocular lenses. J Cataract Refract Surg. 2016;42:846–54. A Comparative study illustrating that DSAEK with transscleral-sutured IOLs developed postoperative CME at higher incidnece than solitary DSAEK.

    PubMed  Google Scholar 

  21. Phillips PM, Phillips LJ, Much JW, Maloney C. Descemet stripping endothelial keratoplasty: six-month results of the first 100 consecutive surgeries performed solo by a surgeon using 1 technique with 100% follow-up. Cornea. 2012;31:1361–4.

    PubMed  Google Scholar 

  22. Suh LH, Yoo SH, Deobhakta A, Donaldson KE, Alfonso EC, Culbertson WW, et al. Complications of Descemet’s stripping with automated endothelial keratoplasty: survey of 118 eyes at one institute. Ophthalmology. 2008;115:1517–24.

    PubMed  Google Scholar 

  23. Pedemonte-Sarrias E, Salvador Playa T, Sassot Cladera I, Gris O, Ribas Martinez J, Garcia-Arumi J, et al. Incidence of cystoid macular edema after Descemet’s stripping automated endothelial keratoplasty. Int J Ophthalmol. 2017;10:1081–7.

    PubMed  PubMed Central  Google Scholar 

  24. Inoda S, Hayashi T, Takahashi H, Oyakawa I, Yokogawa H, Kobayashi A, et al. Risk factors for cystoid macular edema after Descemet membrane endothelial Keratoplasty. Cornea. 2019;38:820–4.

    PubMed  PubMed Central  Google Scholar 

  25. Kocaba V, Mouchel R, Fleury J, Marty AS, Janin-Manificat H, Maucort-Boulch D, et al. Incidence of cystoid macular edema after Descemet membrane endothelial Keratoplasty. Cornea. 2018;37:277–82.

    PubMed  PubMed Central  Google Scholar 

  26. Ampazas P, Droutsas K, Giallouros E, Schroeder FM, Sekundo W. Comparison of 5% sulfur hexafluoride versus 100% air Tamponade in Descemet membrane endothelial Keratoplasty. Cornea. 2017;36:1189–94.

    PubMed  Google Scholar 

  27. Quilendrino R, Rodriguez-Calvo de Mora M, Baydoun L, Ham L, van Dijk K, Dapena I, et al. Prevention and management of Descemet membrane endothelial Keratoplasty complications. Cornea. 2017;36:1089–95.

    PubMed  Google Scholar 

  28. •• Hoerster R, Stanzel TP, Bachmann BO, Siebelmann S, Felsch M, Cursiefen C. Intensified Topical Steroids as Prophylaxis for Macular Edema After Posterior Lamellar Keratoplasty Combined With Cataract Surgery. Am J Ophthalmol. 2016;163:174–9.e2. A comparative analysis illustrating the effects of the prophylaxis treatment of topical intensive steroid following triple-DMEK surgery.

    CAS  PubMed  Google Scholar 

  29. Flanary WE, Vislisel JM, Wagoner MD, Raecker ME, Aldrich BT, Zimmerman MB, et al. Incidence of cystoid macular edema after Descemet membrane endothelial Keratoplasty as a staged and solitary procedure. Cornea. 2016;35:1040–4.

    PubMed  Google Scholar 

  30. Heinzelmann S, Maier P, Bohringer D, Huther S, Eberwein P, Reinhard T. Cystoid macular oedema following Descemet membrane endothelial keratoplasty. Br J Ophthalmol. 2015;99:98–102.

    PubMed  Google Scholar 

  31. Chaurasia S, Price FW Jr, Gunderson L, Price MO. Descemet’s membrane endothelial keratoplasty: clinical results of single versus triple procedures (combined with cataract surgery). Ophthalmology. 2014;121:454–8.

    PubMed  Google Scholar 

  32. Dapena I, Ham L, Droutsas K, van Dijk K, Moutsouris K, Melles GR. Learning curve in Descemet’s membrane endothelial Keratoplasty: first series of 135 consecutive cases. Ophthalmology. 2011;118:2147–54.

    PubMed  Google Scholar 

  33. Ersoy L, Caramoy A, Ristau T, Kirchhof B, Fauser S. Aqueous flare is increased in patients with clinically significant cystoid macular oedema after cataract surgery. Br J Ophthalmol. 2013;97:862–5.

    PubMed  Google Scholar 

  34. Inoue T, Kawaji T, Inatani M, Kameda T, Yoshimura N, Tanihara H. Simultaneous increases in multiple proinflammatory cytokines in the aqueous humor in pseudophakic glaucomatous eyes. J Cataract Refract Surg. 2012;38:1389–97.

    PubMed  Google Scholar 

  35. Miyake K, Ibaraki N. Prostaglandins and cystoid macular edema. Surv Ophthalmol. 2002;47(Suppl 1):S203–18.

    PubMed  Google Scholar 

  36. Yamaguchi T, Higa K, Suzuki T, Nakayama N, Yagi-Yaguchi Y, Dogru M, et al. Elevated cytokine levels in the aqueous humor of eyes with bullous Keratopathy and low endothelial cell density. Invest Ophthalmol Vis Sci. 2016;57:5954–62.

    CAS  PubMed  Google Scholar 

  37. • Yagi-Yaguchi Y, Yamaguchi T, Higa K, Suzuki T, Aketa N, Dogru M, et al. Association between corneal endothelial cell densities and elevated cytokine levels in the aqueous humor. Sci Rep. 2017;7:13603. Of impotance cytokine analysis elucidating that multipe inflammatory cytokines in the anterior chamber accelerated corneal endothelial cell loss.

    PubMed  PubMed Central  Google Scholar 

  38. •• Ishii N, Yamaguchi T, Yazu H, Satake Y, Yoshida A, Shimazaki J. Factors associated with graft survival and endothelial cell density after Descemet's stripping automated endothelial keratoplasty. Sci Rep. 2016;6:25276. This manuscript elucidated that there was a rapid postoperative endothelial cell loss in patients with severe pre-existing iris damage.

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Huang W, Chen S, Gao X, Yang M, Zhang J, Li X, et al. Inflammation-related cytokines of aqueous humor in acute primary angle-closure eyes. Invest Ophthalmol Vis Sci. 2014;55:1088–94.

    CAS  PubMed  Google Scholar 

  40. Du S, Huang W, Zhang X, Wang J, Wang W, Lam DS. Multiplex cytokine levels of aqueous humor in acute primary angle-closure patients: fellow eye comparison. BMC Ophthalmol. 2016;16:6.

    PubMed  PubMed Central  Google Scholar 

  41. •• Itakura H, Kishi S, Li D, Akiyama H. Observation of posterior precortical vitreous pocket using swept-source optical coherence tomography. Invest Ophthalmol Vis Sci. 2013;54:3102–7. A clinical study using swept-source optical coherence tomography elucidating that there was a channel connecting Cloquet’s canal and posterior precortical vitreous pocket, which suggests the route of aqueous humor into the retina.

    PubMed  Google Scholar 

  42. Miyake K, Sugiyama S, Norimatsu I, Ozawa T. Prevention of cystoid macular edema after lens extraction by topical indomethacin (III) radioimmunoassay measurement of prostaglandins in the aqueous during and after lens extraction procedures. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1978;209:83–8.

    CAS  PubMed  Google Scholar 

  43. • Kitazawa K, Kayukawa K, Wakimasu K, Inatomi T, Hieda O, Mori K, et al. Topical non-steroidal anti-inflammatory drugs for the treatment of cystoid macular edema post Descemet’s stripping automated endothelial keratoplasty. Jpn J Ophthalmol. 2018;62:615–20. A retrospective study assessed the effects of topical NSAIDs eye drops in patients with CME following DSAEK.

    CAS  PubMed  Google Scholar 

  44. Flach AJ. Cyclo-oxygenase inhibitors in ophthalmology. Surv Ophthalmol. 1992;36:259–84.

    CAS  PubMed  Google Scholar 

  45. Heier JS, Topping TM, Baumann W, Dirks MS, Chern S. Ketorolac versus prednisolone versus combination therapy in the treatment of acute pseudophakic cystoid macular edema. Ophthalmology. 2000;107:2034–8 discussion 9.

    CAS  PubMed  Google Scholar 

  46. Miyake K, Masuda K, Shirato S, Oshika T, Eguchi K, Hoshi H, et al. Comparison of diclofenac and fluorometholone in preventing cystoid macular edema after small incision cataract surgery: a multicentered prospective trial. Jpn J Ophthalmol. 2000;44:58–67.

    CAS  PubMed  Google Scholar 

  47. Hamzaoglu EC, Straiko MD, Mayko ZM, Sales CS, Terry MA. The first 100 eyes of standardized Descemet stripping automated endothelial Keratoplasty versus standardized Descemet membrane endothelial Keratoplasty. Ophthalmology. 2015;122:2193–9.

    PubMed  Google Scholar 

  48. Lee WB, Jacobs DS, Musch DC, Kaufman SC, Reinhart WJ, Shtein RM. Descemet's stripping endothelial keratoplasty: safety and outcomes: a report by the American Academy of ophthalmology. Ophthalmology. 2009;116:1818–30.

    PubMed  Google Scholar 

  49. Shimazaki J, Saito H, Yang HY, Toda I, Fujishima H, Tsubota K. Persistent epithelial defect following penetrating keratoplasty: an adverse effect of diclofenac eyedrops. Cornea. 1995;14:623–7.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan

    Koji Kitazawa & Chie Sotozono

  2. Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Shigeru Kinoshita

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  1. Koji Kitazawa
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  3. Shigeru Kinoshita
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Correspondence to Koji Kitazawa.

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Kitazawa, K., Sotozono, C. & Kinoshita, S. Incidence and Management of Cystoid Macular Edema after Corneal Transplantation. Curr Ophthalmol Rep 8, 201–207 (2020). https://doi.org/10.1007/s40135-020-00248-8

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