Cystoid macular oedema is an inflammatory condition affecting the central retina that can develop in the weeks following cataract surgery. ¹ It is one of the more common causes of unexpectedly poor central vision in the early postoperative period and should be considered in any patient whose vision has not improved as anticipated, or has deteriorated after an initial period of good recovery.
The condition arises when inflammatory mediators released during surgery cause fluid to accumulate in the layers of the macula, the area of the retina responsible for central, detailed vision. ³ Patients typically notice blurred or distorted central vision, reduced contrast sensitivity and sometimes a mild central scotoma. Peripheral vision is generally unaffected.
Diagnosis is confirmed with optical coherence tomography, which provides high-resolution cross-sectional imaging of the macula and clearly demonstrates the characteristic cyst-like spaces within the retinal layers. Treatment typically involves topical anti-inflammatory drops, including non-steroidal anti-inflammatory agents and corticosteroids, and in the majority of cases the oedema resolves fully with appropriate therapy. ¹
Patients with diabetes, a history of uveitis or previous retinal vein occlusion are at higher risk and may require more intensive monitoring and treatment. ²
References
1. Henderson BA, Kim JY, Ament CS, Ferrufino-Ponce ZM, Grabowska A, Cremers SL. Clinical pseudophakic cystoid macular edema. Journal of Cataract and Refractive Surgery. 2007;33(9):1550–1558.
2. Wielders LHP, Schouten JSAG, Winkens B, et al. European multicenter trial of the prevention of cystoid macular edema after cataract surgery in diabetics: ESCRS PREMED Study Report 2. Journal of Cataract and Refractive Surgery. 2018;44(4):429–439.
3. Lobo CL, Faria PM, Soares MA, Bernardes RC, Cunha-Vaz JG. Macular alterations after small-incision cataract surgery. Journal of Cataract and Refractive Surgery. 2004;30(4):752–760.
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