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Long-term outcomes of patients with myopic traction maculopathy after phacoemulsification for incident cataract.

ABSTRACT: PURPOSE:To evaluate the long-term effect of cataract surgery on highly myopic patients with myopic traction maculopathy (MTM) and the risk factors associated with MTM progression. METHODS:Highly myopic patients with cataract and MTM were included. Phacoemulsification surgery was performed on patients who had vision loss below 20/63 and were willing to operation. Exclusion criteria included full thickness macular hole, foveal/retinal detachment, history of vitreoretinal surgery, myopic choroidal neovascularization, macular chorioretinal atrophy, peripheral lattice degeneration, incomplete follow up, or intraoperative complications. All patients underwent a complete ophthalmological examination. Optical coherence tomography examinations and microperimetry examinations were performed. RESULTS:A total of 229 patients (mean age: 57?±?6 years) were recruited, including 179 operated patients and 50 unoperated patients. Both the best corrected visual acuity (BCVA) and macular sensitivity (MS) were significantly improved after cataract surgeries throughout the follow-up period (p?=?0.000). No difference was found in the proportion of MTM staging and in the rate of resolving/stable or progressive MTM (p?=?0.757) between the operated and the unoperated groups. Of all patients, those with S2 to S4 MTM at baseline had significantly higher risk of progressive MTM (p?

SUBMITTER: Cai L

PROVIDER: S-EPMC7002422 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Long-term outcomes of patients with myopic traction maculopathy after phacoemulsification for incident cataract.

Cai Lei L Sun Zhongcui Z Guo Diwen D Fan Qi Q Zhu Xiangjia X Yang Jin J Lu Yi Y

Eye (London, England) 20190405 9

<h4>Purpose</h4>To evaluate the long-term effect of cataract surgery on highly myopic patients with myopic traction maculopathy (MTM) and the risk factors associated with MTM progression.<h4>Methods</h4>Highly myopic patients with cataract and MTM were included. Phacoemulsification surgery was performed on patients who had vision loss below 20/63 and were willing to operation. Exclusion criteria included full thickness macular hole, foveal/retinal detachment, history of vitreoretinal surgery, my ...[more]

PMID: 30952957

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Project description:BackgroundMinimally invasive glaucoma surgeries (MIGS) have attracted significant attention, as they have been reported to lower intra-ocular pressure (IOP) and have an excellent safety profile. The iStent is an example of a minimally invasive glaucoma device that has received particular attention due to its early and wide spread utilization. There is a growing body of evidence supporting its use at the time of phacoemulsification to help lower IOP. However, it is still not clear how much of the IOP lowering effect can be attributed to the iStent, the crystalline lens extraction or both when inserted concurrently at the time of phacoemulsification. This has been an important issue in understanding its potential role in the glaucoma management paradigm.PurposeTo conduct a systematic review and meta-analysis comparing the IOP lowering effect of iStent insertion at the time of phacoemulsification versus phacoemulsification alone for patients with glaucoma and cataracts.MethodsA systematic review was conducted utilizing various databases. Studies examining the IOP lowering effect of iStent insertion in combination with phacoemulsification, as well as studies examining the IOP lowering effect of phacoemulsification alone were included. Thirty-seven studies, reporting on 2495 patients, met the inclusion criteria. The percentage reduction in IOP (IOPR%) and mean reduction in topical glaucoma medications after surgery were determined. The standardized mean difference (SMD) was computed as a measure of the treatment effect for continuous outcomes taking into account heterogeneity. Fixed-effect and random-effect models were applied.ResultsA 4% IOP reduction (IOPR%) from baseline occurred following phacoemulsification as a solo procedure compared to 9% following an iStent implant with phacoemulsification, and 27% following 2 iStents implants with phacoemulsification. Compared with cataract extraction alone, iStent with phacoemulsification resulted in significant reduction in the post-operative IOP (IOPR%) (SMD = -0.46, 95% CI: [-0.87, -0.06]). A weighted mean reduction in the number of glaucoma medications per patient was 1.01 following phacoemulsification alone compared to 1.33 after one iStent implant with phacoemulsification, and 1.1 after 2 iStent implants with phacoemulsification. Compared to cataract extraction alone, iStent with cataract extraction showed a significant decrease in the number of glaucoma medications (SMD = -0.65, 95% CI: [-1.18, -0.12]). Funnel plots suggested the absence of publication bias.ConclusionBoth iStent implantation with concurrent phacoemulsification and phacoemulsification alone result in a significant decrease in IOP and topical glaucoma medications. In terms of both reductions, iStent with phacoemulsification significantly outperforms phacoemulsification alone.

Project description:Importance:Although myopic maculopathy has become a major cause of vision impairment worldwide, few data from Russia and Central Asia on the prevalence of myopic maculopathy have been available. Objective:To assess the prevalence of myopic maculopathy and its associations with ocular and systemic parameters in a population in Russia. Design, Setting, and Participants:The Ural Eye and Medical Study, a population-based case-control study, was conducted in rural and urban areas in Bashkortostan, Russia, from October 26, 2015, to July 4, 2017. Data analysis was performed from September 13 to September 15, 2019. The Ural Eye and Medical Study included 5899 of 7328 eligible individuals (80.5%) aged 40 years or older. Exposures:A detailed ocular and systemic examination included fundus photography and optic coherence tomography for the assessment of myopic maculopathy. Main Outcomes and Measures:Prevalence of myopic maculopathy. Results:The present investigation included 5794 of the 5899 eligible individuals (98.2%; 3277 [56.6%] women; mean [SD] age, 58.9 [10.7] years) with available information about myopic maculopathy. Mean (SD) axial length was 23.3 (1.1) mm (range, 19.78-32.87 mm). Prevalence of any myopic maculopathy was 1.3% (95% CI, 1.0%-1.6%); myopic maculopathy stage 2, 0.8% (95% CI, 0.6%-10.0%); stage 3, 0.2% (95% CI, 0.1%-0.4%); and stage 4, 0.2% (95% CI, 0.1%-0.4%). The prevalence of moderate to severe vision impairment and blindness was 29.8% (14 of 47 participants; 95% CI, 16.2%-43.3%) in stage 2 myopic maculopathy, 57.1% (8 of 14 participants; 95% CI, 27.5%-86.8%) in stage 3, and 100% (13 of 13 participants; 95% CI, 100%-100%) in stage 4. In multivariable analysis, a higher myopic maculopathy prevalence was associated with longer axial length (odds ratio [OR], 4.54; 95% CI, 3.48-5.92; P < .001), older age (OR, 1.04; 95% CI, 1.01-1.07; P = .03), and thinner peripapillary retinal nerve fiber layer thickness (OR, 0.96; 95% CI, 0.95-0.98; P < .001). After exclusion of glaucomatous eyes, the association between myopic maculopathy prevalence and thinner retinal nerve fiber layer remained significant (OR, 0.96; 95% CI, 0.95-0.98; P < .001). Myopic maculopathy prevalence was not significantly associated with sex; region of habitation; level of education; ethnicity; prevalence of arterial hypertension, chronic obstructive pulmonary disease, chronic kidney disease, diabetes, and inflammatory liver disease; hearing loss; depression score; or anxiety score. Conclusions and Relevance:In this ethnically mixed population from Russia, myopic maculopathy prevalence was mainly associated with elongated axial length and thinner peripapillary retinal nerve fiber layer, but was not associated with any major internal medical disease, level of education, ethnicity, or sex. Higher myopic maculopathy stage was associated with vision impairment and blindness. In addition to a known association between high axial myopia and glaucoma, myopic maculopathy may be associated with nonglaucomatous optic neuropathy.

Dataset Information

Long-term outcomes of patients with myopic traction maculopathy after phacoemulsification for incident cataract.

Publications

Long-term outcomes of patients with myopic traction maculopathy after phacoemulsification for incident cataract.

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