Comparative Incidence of Cystoid Macular Edema after Secondary Intraocular Lens Placement Versus Routine and Complex Cataract Surgery
In brief
Secondary IOL placement yields 5% macular edema, three times routine risk
In a US database of over 600,000 eyes, cystoid macular edema occurred in 5.1% after secondary intraocular lens implantation, versus 1.4% after routine cataract surgery and 2.0% after complex cases-a threefold increase. The higher rate coincided with less prophylactic NSAID use and was further amplified when surgery was combined with pars plana vitrectomy.
- Journal
- Retina (Philadelphia, Pa.) (Q1)
- Published
- 31 August 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Charles Zhang, Sinan Ersan, Alexander S Bae, Bryant A Menke, Basil K Williams, Justin H Townsend, et al.
- PMID
- 42671901
- DOI
- 10.1097/IAE.0000000000005003
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 3 September 2026): Higher CME incidence after secondary IOL placement
Abstract
PURPOSE: To compare the cumulative incidence of postoperative cystoid macular edema (CME) after secondary intraocular lens (IOL) placement versus routine and complex cataract surgery. METHODS: 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. RESULTS: 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). CONCLUSIONS: Secondary IOL placement is associated with a higher risk of postoperative CME compared to primary and complex cataract surgery.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.