Comparative Incidence of Cystoid Macular Edema after Secondary Intraocular Lens Placement Versus Routine and Complex...

To compare the cumulative incidence of postoperative cystoid macular edema (CME) after secondary intraocular lens (IOL) placement versus routine and complex cataract surgery.

This retrospective cohort study utilized the TriNetX US Collaborative Network to identify all adult patients who underwent routine cataract surgery, complex cataract surgery, or secondary IOL placement. Propensity score matching was performed, and 90-day CME incidence was compared between groups using relative risks (RRs) with 95% confidence intervals (CIs). Multivariable Cox proportional hazards models were performed to assess the relative hazard of CME, including an analysis of the effect of concurrent pars plana vitrectomy (PPV) in the secondary IOL group.

A total of 506,095 routine cataract, 99,337 complex cataract, and 12,644 secondary IOL surgeries met inclusion criteria. The incidence of postoperative CME after secondary IOL placement was 5.1%, significantly higher than routine cataract surgery (1.4%; risk ratio [RR] 3.6; p<0.0001) and complex cataract surgery (2.0%; RR 2.5; p<0.0001). Multivariable Cox proportional hazards models demonstrated an increased risk of CME in patients that had undergone secondary IOL implantation compared to routine cataract surgery (hazard ratio 3.6; p<0.0001). Of the patients that had undergone secondary IOL placement, concurrent PPV was associated with an increased risk of postoperative CME (7.1% vs 5.3%; p<0.0001). Patients who had undergone secondary IOL placement had a lower utilization of prophylactic NSAID eyedrops compared to primary cataract cases (23% vs 32-34%, p<0.0001).

Secondary IOL placement is associated with a higher risk of postoperative CME compared to primary and complex cataract surgery.