Postsurgical Cystoid Macular Edema

Abstract

Cystoid macular edema (CME) is a primary cause of reduced vision following both cataract and successful vitreoretinal surgery. The incidence of clinical CME following modern cataract surgery is 0.1-2.35%. Preexisting conditions such as diabetes mellitus and uveitis as well as intraoperative complications can raise the risk of developing CME postoperatively. The etiology of CME is not completely understood. Prolapsed or incarcerated vitreous and postoperative inflammatory processes have been proposed as causative agents. Pseudophakic CME is characterized by poor postoperative visual acuity. Fluorescein angiography is indispensable in the workup of CME, showing the classical perifoveal petaloid staining pattern and late leakage of the optic disk. Optical coherence tomography is a useful diagnostic tool, which displays cystic spaces in the outer nuclear layer. The most important differential diagnoses include age-related macular degeneration and other causes of CME such as diabetic macular edema. Most cases of pseudophakic CME resolve spontaneously. The value of prophylactic treatment is doubtful. First-line treatment of postsurgical CME should include topical nonsteroidal anti-inflammatory drugs and corticosteroids. Oral carbonic anhydrase inhibitors can be considered complementary. In cases of resistant CME, periocular or intraocular corticosteroids present an option. Antiangiogenic agents, though experimental, should be considered for nonresponsive persistent CME. Surgical options should be reserved for special indications.

Topical Nonsteroidal Anti-Inflammatory Drugs for Macular Edema

“…Despite advances in technique and surgical materials, cystoid macular edema (CME) is the most frequent cause of reduced vision following uneventful modern cataract surgery, with a seemingly rare incidence of 0.1–2.35% for clinically significant CME [62–64]. Also known as Irvine-Gass syndrome, it is mainly caused by the accumulation of extracellular fluid within the retina due to leakage from dilated capillaries [1, 16, 63].…”

“…The range of the reported incidence rates is wide (0.10–2.35% for clinically important CME, defined as a retinal thickening within 500 microns of the center of the macula causing a significant vision impairment) [62, 64], which may be due to the different patient populations, cataract stages, surgical techniques, and, particularly, diagnostic methods utilized by the relevant studies. Notably, after small-incision cataract surgery the reported rates of CME range from 9 to 19% based on fluorescein angiography and are as high as 41% as determined by OCT [66–68], although clinically important CME is far less common [1, 69].…”

Retinal Complications after Damaging the Vitreolenticular Barrier

“…After uneventful extracapsular cataract surgery, CME occurs in 0.1–2.35% of all cases (Irvine-Gass syndrome) [35]. However, after opening the vitreolenticular interface, this incidence significantly rises up to 21% in cases of complicated cataract surgery with vitreous loss [36,37].…”

Prevention of macular oedema after cataract surgery in patients with diabetes mellitus

“…Клинически значимый КМО можно выявить уже при оф-тальмоскопии, данная форма сопровождается снижением остроты зрения и обнаруживается в 0,1-2,35% [7,8]; по дан-ным флуоресцентной ангиографии (ФАГ) к концу первого месяца после операции КМО встречается в 16-40% слу-чаев [9]; по данным оптической когерентной томографии (ОКТ) -в 7,5% [10]. Вероятность развития КМО в послеопе-рационном периоде существенно повышается у пациентов группы риска, к которым относятся пациенты с СД.…”