New observation of microcystic macular edema as a mild form of cystoid macular lesions after standard phacoemulsification

Abstract

We present the new observations of postoperative microcystic macular edema (MME) as a mild form of cystoid macular lesions (CMLs) after standard phacoemulsification.To report the incidence, risk factors, and pathophysiology of MME compared to conventional concept of pseudophakic cystoid macular edema (CME), we retrospectively reviewed patients’ records. Pseudophakic CMLs were defined as any cystic fluid collections that were newly formed after cataract surgery, confirmed by preoperative and postoperative optical coherence tomography (OCT) examinations. CMLs were classified into 2 groups, which are CME and MME, according to the change the central retinal thickness. The dataset consisted of 316 patients (mean age, 67.52 ± 12.95 years; range, 42–87 years). Topical nonsteroidal anti-inflammatory drug (NSAID) were administered in 197 eyes during the perioperative period; 147 eyes were not treated. CMLs were present in 22 out of 344 (6.39%) eyes. Six of 344 eyes (1.74%) had CME and 16 of 344 eyes (4.65%) had MME. The incidence of MME significantly decreased in the group of patients treated with topical NSAIDs (P = .039), while the incidence of CME was not different in both groups (P = .408). All of the patients with MME were experienced improvement with only topical NSAIDs. However, 67% (4/6) of patients with CME did not improve with topical NSAIDs alone and needed additional treatments. Pseudophakic MMEs were more likely to have a history of diabetic retinopathy, epiretinal membrane, and eyes were not treated with topical NSAID.This study showed a wide clinical spectrum of CMLs. MME has not been included in the conventional definition of pseudophakic CME. Topical NSAIDs could decrease the CML incidence. People with risk factors for CML should use topical NSAIDs and undergo regular follow-up OCT examinations.

OCT changes of idiopathic epiretinal membrane after cataract surgery

“…A second aspect to consider is the improvement in the OCT technology, which allowed us to be way more sensitive in CME detection. According to a recently published paper by Dong H. Yoon et al, we classified as CME even the microcystic macular edema that is in fact a mild form of CME [12]. This increased sensitivity is confirmed by the fact that even preoperatively, one-fourth of our patients already had CME.…”

Evaluation of Choroid Thickness Changes After Uneventful Phacoemulsification Surgery Using Spectral Domain Optical Coherence Tomography at a Tertiary Care Eye Hospital

“…13 Cataract surgery, although anterior segment procedure is capable of affecting posterior segment especially in Diabetic retinopathy and Irvine-Gass Syndrome (pseudophakic cystoid macular edema). 14 Dense scanning afforded by SD-OCT allows identification of such retinochoroidal vascular and morphological patterns.…”

Occurrence of cystoid macular edema after uneventful phacoemulsification in diabetic patients without retinopathy: A hospital-based comparative study

“…Various theories have been put forward explaining the pathogenesis of PCME of which post-surgical release of prostaglandins leading to inflammation and breakdown of the blood-retinal barrier is widely accepted (Ursell et al, 1999;Miyake and Ibaraki, 2002). The incidence of PCME after uneventful phacoemulsification in the healthy population is around 0.1-2.3% (Chu et al, 2016;Yoon et al, 2018). Various risk factors such as any chronic inflammation, uveitis, any preexisting maculopathy, previous ocular surgery and diabetes can affect the development of CME apart from surgical complications.…”