Combined Ab Interno Glaucoma Surgery Does not Increase the Risk of Pseudophakic Cystoid Macular Edema in Uncomplicated Eyes

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To assess the risk of pseudophakic cystoid macular edema (PCME) following cataract surgery (bimanual phacoemulsification with posterior chamber lens implantation) combined with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) compared with solely cataract extraction.

Patients and Methods:

In total, 360 consecutive eyes of 180 patients with age-related cataract, and thereof 162 with coexistent glaucoma, who underwent sole cataract surgery or in combination with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) were compared retrospectively regarding PCME development. Patients with known risk factors of PCME were excluded. Macular examination was performed using spectral-domain optical coherence tomography before and at 4, 8, 12, 16, 24, 36, and 48 weeks after surgery. Main outcome measure was the incidence of PCME.


In total, 126 eyes (35%) underwent cataract surgery combined with ab interno glaucoma surgery (96 trabecular aspiration (76.2%), 30 ab interno trabeculotomy (23.8%), and 234 eyes (65%) received cataract surgery alone. PCME overall occurred in 23 eyes (6.4%). Following combined trabecular aspiration 5 eyes (5.2%) developed PCME, following ab interno trabeculotomy 2 eyes (6.7%), and following sole cataract surgery 16 eyes (6.8%), reaching no significant difference (P=0.676). Risk of PCME in fellow eye was significantly increased (P=0.025; odds ratio 7.177; 95% confidence interval, 5.667-8.687).


Additional ab interno glaucoma surgery combined with phacoemulsification does not seem to increase the risk of PCME in uncomplicated eyes. However, in patients with history of PCME a significantly increased risk of PCME in fellow eye should be taken into account.

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