Choroid thickness: a potential biomarker for pseudophakic cystoid macular oedema

Aims: To determine whether choroidal thickness influences the risk of clinically significant pseudophakic cystoid macular oedema (CME).

Methods: We performed a retrospective case-control study of non-diabetic adults who underwent uncomplicated cataract surgery at the Eye & ENT Hospital of Fudan University between June 2023 and December 2024. Electronic records were reviewed to estimate pseudophakic CME incidence. For each CME case diagnosed, age-matched and sex-matched patients without CME within 3 months postoperatively were randomly selected as controls. Potential ocular risk factors, including axial length (AL), central retinal thickness, subfoveal choroidal thickness (SFCT), posterior vitreous detachment (PVD) and others, were assessed with multivariable logistic regression. Treatment methods and prognosis of CME cases were also evaluated.

Results: Among 9793 eyes, CME occurred in 65 (0.66%). After age adjustment, eyes with AL <26 mm (age-related cataract, ARC) had higher CME risk than those with AL ≥26 mm (highly myopic catar, HMC) (OR=1.94, p=0.046). Compared with matched controls, CME cases had shorter AL, less PVD and thicker SFCT (all p<0.001). In multivariable analysis, only thicker SFCT remained associated with CME (OR=1.012, p<0.001). SFCT predicted CME with areas under the curve of 0.805 in HMC and 0.792 in ARC. Mean recovery time was 38.7±9.6 days with periocular steroid injection plus topical steroid and non-steroidal anti-inflammatory drugs versus 42.4±12.3 days with topical therapy alone. Cox regression confirmed faster recovery with the combined regimen.

Conclusions: Thinner choroidal thickness, which is common in high myopia, acts as a protective factor against pseudophakic CME.