Cystoid Macular Edema

Cystoid macular edema in a case of chronic macular pucker. 

  • One of the most common cause of vision loss following uncomplicated cataract removal either with or without implantation of intraocular lens
  • Other conditions that may be complicated with CME include: diabetes, intraocular inflammation, vascular occlusions, epiretinal membrane, macroaneurysm, exudative age-related macular degeneration, hypotony and retinal detachment

Clinical features:

  • Symptoms:
    • Reduced visual acuity
    • Hyperopic shift refraction
  • Signs:
    • Loss of foveal depression
    • Thickening of the retina associated with translucent intraretinal cystoid spaces at the posterior pole

Fluorescein angiography demonstrates:

  • Dye leakage from small points in the midsection of each capillaries
  • Pooling of fluorescein in obliquely oriented henle layer which gives rise a characteristic petaloid staining patter in the perifoveal region
  • Late staining of the optic nerve is associated with inflammatory CME, typically after cataract extraction
  • Optical coherence tomography (OCT) is very helpful for diagnosis as well as for follow-up of treatment

Management:

  • Rule out infectious process, intraocular derangement such as entrapment of the iris or vitreous prolapse in the wound, uveitis or diabetic retinopathy
  • Therapeutic approach with topical corticosteroid or cyclo-oxygenase inhibitor
  • Sub-tenon's or intravitreal corticosteroid injection in refractory cases
  • Nd:YAG laser vitreolysis
  • Vitrectomy in selected cases
  • Intraocular lens removal or replacement