Role of Cold Balanced Salt Solution (BSS) in the Prophylaxis of Cystoid Macular Edema After Cataract Surgery: A Prospective Randomized Study

Alessandro Meduri; Giovanni William Oliverio; Loredana Bergandi; Gabriella De Salvo; Rino Frisina; Cosimo Mazzotta; Pasquale Aragona

doi:10.2147/OPTH.S304146

Role of Cold Balanced Salt Solution (BSS) in the Prophylaxis of Cystoid Macular Edema After Cataract Surgery: A Prospective Randomized Study

Clin Ophthalmol. 2021 Jun 17:15:2519-2526. doi: 10.2147/OPTH.S304146. eCollection 2021.

Authors

Alessandro Meduri¹, Giovanni William Oliverio¹, Loredana Bergandi², Gabriella De Salvo³, Rino Frisina⁴, Cosimo Mazzotta^{5

6}, Pasquale Aragona¹

Affiliations

¹ Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy.
² Department of Oncology, University of Torino, Turin, Italy.
³ Eye Unit, University Hospital Southampton Foundation Trust, Southampton, UK.
⁴ Department of Neurosciences - Ophthalmology, University of Padova, Padua, Italy.
⁵ Departmental Ophthalmology Unit, Alta Val d'Elsa Hospital, Siena, Italy.
⁶ Siena Crosslinking Center, Siena, Italy.

Abstract

Purpose: To evaluate the postoperative effect on central retinal macular thickness of a cooled irrigating eye solution used during cataract surgery.

Patients and methods: In this prospective, single-center study, 100 eyes of 50 patients (26 males and 24 females) were evaluated with spectral domain optical coherence tomography (SD-OCT) before and after phacoemulsification for senile cataract. Eyes were randomly divided into two groups based on the irrigating solution used during surgery: Group 1, 50 eyes received intraoperative irrigating solution at room temperature (~20.0±0.1°C); and Group 2, 50 fellow eyes received cold intraoperative irrigating solution (2.7±0.1°C). Changes in central macular thickness (CMT) were evaluated in both groups by SD-OCT macular raster scan for the nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields and total macular volume, performed pre-surgery, and 1 and 4 weeks post-surgery.

Results: Despite there being no significant differences in variables between the two groups preoperatively, significant increases in CMT were observed at 1 week after surgery in both groups (p=0.02 and p=0.03, respectively), as well as in total macular volume (p<0.0001 and p=0.02, respectively). Inter-subgroup analysis showed a significant reduction in CMT (p=0.03) and total macular volume (p=0.001) at 1 week post-surgery in Group 2 compared to Group 1, whereas no significant differences were observed at 4 weeks.

Conclusion: The use of a cooled irrigating eye solution during phacoemulsification may be beneficial in preventing the possible development of postoperative macular thickening. Further clinical studies may support this finding.

Keywords: cataract surgery; central macular thickness; cold intraoperative irrigating solution; cystoid macular edema; phacoemulsification; spectral domain optical coherence tomography.

Grants and funding

The authors received no financial support for the research, authorship, and publication of this article. Dr De Salvo received consultancy fees from Heidelberg Engineering, Novartis, Allergan, and Bayer, not related to this manuscript.