Cystoid Macular Edema After Cultured Human Corneal Endothelial Cell Injection: Frequency, Associated Factors, and Visual Outcomes.

Abstract

To evaluate the frequency, timing, factors associated with, and visual impact of cystoid macular edema (CME) detected after cultured human corneal endothelial cell (cHCEC) injection therapy. Multicenter retrospective clinical cohort study. Fifty-seven eyes of 57 patients who underwent cHCEC injection therapy at 3 tertiary ophthalmic institutions in Japan. Clinical records were reviewed retrospectively. CME was defined as the presence of intraretinal cystoid spaces with or without macular thickening detected by spectral-domain optical coherence tomography. Clinical factors associated with postoperative CME were evaluated using univariate analyses. Kaplan-Meier analysis was performed to assess time to postoperative detection of CME according to preoperative prostaglandin analog use. Postoperative detection of CME, time to CME detection, and postoperative best-corrected visual acuity (BCVA) at 6 months. CME was detected postoperatively in 15 of 57 eyes (26.3%). Preoperative prostaglandin analog use was significantly associated with postoperative CME detection (9/15 [60.0%] vs 6/42 [14.3%], P=.001). Glaucoma (P=.006), use of topical glaucoma medications (P=.006), and worse preoperative BCVA (P=.003) were also associated with CME detection. Kaplan-Meier analysis demonstrated that CME was detected predominantly in the early postoperative period and was significantly more frequent in eyes treated with prostaglandin analogs than in those without prostaglandin analog use (log-rank P=.002). All CME cases resolved following treatment with topical nonsteroidal anti-inflammatory drugs or sub-Tenon triamcinolone acetonide injection. Six-month postoperative BCVA did not differ significantly between eyes with and without CME (logMAR, 0.44 vs 0.60; P=.52). Lens status was not significantly associated with postoperative CME (P=.325). Preoperative macular status was undetermined in 50 of 57 eyes; therefore, pre-existing CME could not be definitively excluded in these eyes. CME was detected postoperatively in approximately one-quarter of eyes after cHCEC injection therapy and was associated with preoperative prostaglandin analog use. Most cases were detected during the early postoperative period and resolved with treatment without adversely affecting 6-month visual outcomes. Careful perioperative management of prostaglandin analogs and routine postoperative optical coherence tomography may facilitate early detection and management of CME.