Cystoid Macular Edema

• 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