Cystoid macular edema

Abstract

We review the epidemiology, pathophysiology, and etiology of cystoid macular edema (CME). Inflammatory, diabetic, post-cataract, and macular edema due to age-related macular degeneration is described. The role of chronic inflammation and hypoxia and direct macular traction is evaluated in each case according to different views from the literature. The different diagnostic methods for evaluating the edema are described. Special attention is given to fluoroangiography and the most modern methods of macula examination, such as ocular coherence tomography and multifocal electroretinography. Finally, we discuss the treatment of cystoid macular edema in relation to its etiology. In this chapter we briefly refer to the therapeutic value of laser treatment especially in diabetic maculopathy or vitrectomy in some selected cases. Our paper is focused mainly on recent therapeutic treatment with intravitreal injection of triamcinolone acetonide and anti-VEGF factors like bevacizumab (Avastin), ranibizumab (Lucentis), pegaptamid (Macugen), and others. The goal of this paper is to review the current status of this treatment for macular edema due to diabetic maculopathy, central retinal vein occlusion and post-cataract surgery. For this reason the results of recent multicenter clinical trials are quoted, as also our experience on the use of intravitreal injections of anti-VEGF factors and we discuss its value in clinical practice.

Fibrinolytic and Surgical Treatment Approaches for Retinal Vein Occlusion

“…On the other hand, it generally takes several months to resolve of the macular edema with these treatment modalities. Macular edema can be persistent despite these options and persistent macular edema may cause irreversible visual loss as a result of apoptosis of the photoreceptors, therefore rapid resolution of macular edema is needed [28] . Although, the mechanisms are not clear, PPV has been suggested as beneficial effects for the rapid resolution of macular edema and retinal damage in patients with RVO.…”

Revisit Rescula and Cystoid Macular Edema and Refractory Glaucoma

“…The occurrence of CME is often associated with various vascular-inflammatory pathological conditions such as diabetic retinopathy, vein occlusion, uveitis, and commonly seen following cataract surgery in a delayed response occurring between 3-12 months. If there is a posterior capsular rupture and vitreous loss, the incidence can reach up to 20% with clinical significance [11]. While revisiting the above two refractory glaucoma cases, the root causes of CME could be one or more of the intraocular surgical complications, of which both patients had suffered, such as posterior capsule rupture, vitreous-macula traction, inflamed flat bleb, endophalmitis, or mitomycine C. Given the nature course of such intractable or refractory disease process, patients usually do not respond well to standard hypotensive medication for glaucoma.…”

Complications Associated with Cataract Surgery

“…Bevacizumab (Avastin) is a monoclonal antibody able to inactivate the effects of vascular endothelial growth factors (VEGF). The role of VEGF in pseudophakic CMO is not clear, yet several authors have reported resolution of CMO after administration of bevacizumab (55) retrospectively. This class of drugs could be of benefit in patients with chronic CMO that have exhibited a steroid hypertensive response to topical or periocular steroids.…”