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- Medically Reviewed by Mr Mfazo Hove Consultant Ophthalmologist
- Author: Chris Dunnington
- Published: December 17, 2024
At Blue Fin Vision® Eye Clinic in London, we understand that cataract surgery is a significant step towards improving your vision and quality of life. While the procedure is generally safe and effective, it’s important to be aware of potential complications that can arise. One such complication is cystoid macular oedema (CMO), also known as Irvine-Gass syndrome. In this comprehensive guide, we’ll explore what CMO is, its causes, symptoms, and treatment options.
What is Cystoid Macular Oedema?
Cystoid macular oedema is a condition that can occur following cataract surgery, where fluid accumulates in the central part of the retina, known as the macula. The macula is responsible for our sharp, detailed central vision, which is crucial for activities like reading, driving, and recognising faces. When CMO develops, it can lead to temporary or, in rare cases, permanent vision impairment.
The term “cystoid” refers to the cyst-like spaces that form within the layers of the macula, filled with fluid. This swelling can distort the macula’s normal structure, leading to visual disturbances.
Incidence of CMO After Cataract Surgery
While cataract surgery is one of the most common and successful eye procedures performed worldwide, CMO remains a potential complication. At Blue Fin Vision® Eye Clinic, we believe in providing our patients with accurate, up-to-date information. Recent studies suggest that the incidence of CMO following uncomplicated cataract surgery ranges from 1% to 2% of cases. However, the risk can be higher in patients with certain pre-existing conditions or complications during surgery.
Causes of Cystoid Macular Oedema After Cataract Surgery
Understanding the causes of CMO is crucial for both prevention and treatment. While the exact mechanisms are not fully understood, several factors contribute to its development:
- Inflammation
The primary cause of CMO is thought to be inflammation triggered by the surgical procedure. During cataract surgery, the eye undergoes manipulation, which can lead to the release of inflammatory mediators. These substances can disrupt the blood-retinal barrier, allowing fluid to accumulate in the macula.
- Surgical Trauma
Although modern cataract surgery techniques are minimally invasive, any manipulation of the eye can potentially cause trauma to delicate ocular structures. This trauma can contribute to the inflammatory response and increase the risk of CMO.
- Pre-existing Conditions
Certain pre-existing eye conditions can increase the risk of developing CMO after cataract surgery. These include:
- Diabetic retinopathy
- Uveitis (inflammation of the uvea)
- Retinal vein occlusion
- Age-related macular degeneration
- Complications During Surgery
While rare, complications during cataract surgery can increase the risk of CMO. These may include:
- Retained lens fragments
- Vitreous loss
- Iris trauma
- Prostaglandin Use
Patients using prostaglandin analogues for glaucoma treatment may have an increased risk of developing CMO after cataract surgery.
Symptoms of Cystoid Macular Oedema
Recognising the symptoms of CMO is crucial for early detection and treatment. At Blue Fin Vision® Eye Clinic, we advise our patients to be vigilant for the following signs:
- Blurred or Distorted Central Vision: This is often the primary symptom. Patients may notice that their vision is not as clear as expected after cataract surgery.
- Decreased Visual Acuity: CMO can cause a reduction in visual sharpness, particularly when reading or focusing on fine details.
- Contrast Sensitivity Loss: Patients may find it difficult to distinguish between shades of grey or perceive contrast in images.
- Colours Appearing Washed Out: Some individuals report that colours seem less vibrant than usual.
- Central Scotoma: In some cases, patients may experience a small, dark or blurry spot in the centre of their vision.
It’s important to note that CMO can develop within a few weeks to several months after cataract surgery. Some patients may not experience noticeable symptoms, especially if the condition is mild. This is why regular post-operative check-ups are essential.
Diagnosis of Cystoid Macular Oedema
At Blue Fin Vision® Eye Clinic in London, we employ state-of-the-art diagnostic techniques to identify and assess CMO. Our comprehensive approach includes:
- Visual Acuity Testing
This basic test measures how well you can see at various distances. A decrease in visual acuity that doesn’t align with the expected post-operative improvement can be an indicator of CMO.
- Dilated Fundus Examination
Our ophthalmologists will dilate your pupils to examine the back of your eye, including the macula, using specialised equipment. This allows for a direct view of any swelling or abnormalities.
- Optical Coherence Tomography (OCT)
OCT is a non-invasive imaging technique that provides high-resolution, cross-sectional images of the retina. It’s particularly effective in detecting and measuring macular oedema, even in its early stages. OCT can reveal:
- The presence and extent of fluid accumulation
- The thickness of the macula
- Any structural changes in the retinal layers
- Fluorescein Angiography
In some cases, we may recommend fluorescein angiography. This involves injecting a fluorescent dye into a vein in your arm, which then circulates through the blood vessels in your eye. Special photographs are taken as the dye passes through the retinal blood vessels, revealing any leakage or abnormal vessel formation.
- Fundus Autofluorescence
This non-invasive imaging technique can help detect changes in the retinal pigment epithelium, which can be affected in CMO.
Early diagnosis is crucial for effective management of CMO. Our team at Blue Fin Vision® Eye Clinic is committed to providing thorough post-operative care to ensure any complications are detected and addressed promptly.
Treatment of Cystoid Macular Oedema
The good news is that CMO is often treatable, and many patients experience significant improvement with appropriate management. At Blue Fin Vision® Eye Clinic, we tailor our treatment approach to each patient’s specific needs. The primary goals of treatment are to reduce inflammation, resolve the macular oedema, and improve vision.
- Topical Medications
The first line of treatment typically involves topical medications:
- Non-steroidal Anti-inflammatory Drugs (NSAIDs): Eye drops such as ketorolac, nepafenac, or bromfenac can help reduce inflammation.
- Corticosteroids: Topical steroids like prednisolone acetate or dexamethasone may be prescribed to combat inflammation more aggressively.
These medications are often used in combination for maximum effect. The duration of treatment can vary from a few weeks to several months, depending on the severity of the CMO and the patient’s response to treatment.
- Oral Medications
In some cases, oral medications may be prescribed:
- Carbonic Anhydrase Inhibitors: Drugs like acetazolamide can help reduce fluid accumulation in the retina.
- Oral NSAIDs: These may be used in conjunction with topical treatments for enhanced anti-inflammatory effects.
- Intravitreal Injections
For more persistent cases of CMO, we may recommend intravitreal injections. These are administered directly into the vitreous cavity of the eye and may include:
- Corticosteroids: Such as triamcinolone acetonide or dexamethasone implants.
- Anti-VEGF Agents: Medications like aflibercept (Eylea), ranibizumab (Lucentis), bevacizumab (Avastin), and faricimab-svoa (Vabysmo), which can help reduce vascular permeability and oedema.
- Surgical Intervention
In rare cases where CMO is severe or unresponsive to other treatments, surgical options may be considered:
- Vitrectomy: This procedure involves removing the vitreous gel from the eye and may be beneficial in cases where vitreomacular traction is contributing to the oedema.
- Removal of the Internal Limiting Membrane: This delicate procedure can sometimes help resolve persistent CMO.
- Management of Underlying Conditions
If CMO is associated with pre-existing conditions like diabetes or uveitis, managing these underlying issues is crucial for long-term success.
Prevention of Cystoid Macular Oedema
At Blue Fin Vision® Eye Clinic, we believe that prevention is always better than cure. We take a proactive and comprehensive approach to minimise the risk of cystoid macular oedema (CMO) following cataract or lens replacement surgery.
Proactive Preventive Measures
- Extended Anti-Inflammatory Regimen: All our surgery patients receive a minimum of 6 weeks of both steroid and non-steroidal anti-inflammatory drops. This combination is highly effective in preventing post-operative CMO.
- Personalised Care: For patients at high risk of developing CMO, we extend this regimen as needed.
- Proven Effectiveness: Our potent preventive approach has resulted in zero cases of post-operative CMO among our patients.
- Comprehensive Care Package: We provide all necessary drops for the duration of treatment, included in our service. When faced with a choice between cost and the best possible care, we always choose the latter.
Additional Preventive Strategies
- Preoperative Assessment: We conduct thorough evaluations to identify risk factors and optimise management of pre-existing conditions.
- Surgical Technique: Our surgeons employ meticulous, minimally traumatic surgical techniques to reduce inflammation.
- Close Postoperative Monitoring: Regular follow-up appointments allow for early detection and intervention if any issues arise.
Our Commitment to Patient Care
At Blue Fin Vision®, we’re committed to providing exceptional care throughout your surgical journey. Our philosophy is simple: if we operate on you, we look after you comprehensively. This includes providing all necessary medications and follow-up care to ensure the best possible outcomes.
While it’s not always possible to prevent CMO entirely, our multi-faceted approach significantly reduces the risk. By combining proactive medication regimens, expert surgical techniques, and close monitoring, we strive to protect your vision and ensure a smooth recovery after cataract or lens replacement surgery.
Prognosis and Long-term Outlook
The prognosis for CMO following cataract surgery is generally good, especially when detected and treated early. Most patients experience improvement in their vision within a few months of starting treatment. However, it’s important to note that in some cases, CMO can persist or recur, requiring ongoing management.
At Blue Fin Vision® Eye Clinic, we’re committed to providing long-term care and support to our patients. We’ll work closely with you to monitor your progress and adjust your treatment plan as needed to ensure the best possible outcome.
Conclusion
Cystoid macular oedema is a potential complication of cataract surgery that, while concerning, is often manageable with proper care and treatment. At Blue Fin Vision® Eye Clinic in London, we combine cutting-edge technology with expert clinical care to provide our patients with the best possible outcomes.
If you’re considering cataract surgery or have concerns about your post-operative vision, we encourage you to reach out to our team. Our experienced ophthalmologists are here to answer your questions, address your concerns, and provide personalised care tailored to your unique needs.
Remember, your vision is precious, and at Blue Fin Vision® Eye Clinic, we’re dedicated to helping you achieve and maintain optimal eye health. Don’t hesitate to contact us for more information or to schedule a consultation. Your journey to clearer vision starts here.
