Cystoid macular edema (CME) is characterized by fluid-filled cysts in the macular region. The most common cause is macular edema after cataract surgery. Other causes include other intraocular surgeries, diabetic retinopathy, age-related macular degeneration, retinal vein occlusions, glaucoma treatment, uveitis, and epiretinal membranes. Treatment involves medical management with NSAIDs, steroids, or anti-VEGF drugs as well as surgical options like vitrectomy if medical treatment fails. Prevention focuses on avoiding complications during cataract surgery to reduce the risk of CME.

1. CYSTOID MACULAR
EDEMA
DR. AJAY I DUDANI
M.S.,DNB,FCPS,DOMS
DR. SHEENA BUCH
DOMS

2. Cystoid Macular Edema- CME
Appearance of fluid filled cystic
spaces in the macular region

3. Cystoid Macular Edema- CME

4. Most Common Cause
Macular edema after cataract surgery
(Irvine-Gass Syndrome)

5. Other Causes
 Other intraocular surgeries
 Non-proliferative Diabetic Retinopathy
 Exudative ARMD with CNVM –serous
detachment of overlying retina and CME

6. Other Causes
 Retinal vein occlusions
 Glaucoma treatment with LATANOPROST
 Retinitis Pigmentosa

7. Other Causes
 Chronic Uveitis
 High doses of Niacin
(for Hypercholesterolemia)
 Epiretinal Membranes

8. Other Causes
 Choroidal tumors
 CMV Retinitis

9. Pathophysiology
 Irvine Gass Syndrome
 Inflammatory cause
 Vascular instability and breakdown of blood
retinal barrier
 Release of cytokines
 Accumulation of fluid in outer plexiform and
inner nuclear layer

10. Pathophysiology
 Diabetes and Vein Occlusions
 Vascular damage directly (endothelial cell
damage)
 In ARMD
 Neovascular membranes are inherently leaky

11. Pathophysiology
 Epiretinal membrane, Vitreo-macular traction
 Direct mechanical forces

12. Clinical Features
 GRADUAL PAINLESS VISION LOSS
 UNIOCULAR OR BINOCULAR –
Depending on etiology
 Vision is typically in the 20/40 to 20/200 range

13. Clinical Examination
 Blunt/irregular retinal foveal reflex
 Retinal thickening
 And/or cysts

14. Additional Examination
 To elicit cause
 Uveitis – presence of ant. Chamber/vitreous
cells
 Epiretinal membrane/Pucker – in macular
region
 Diabetes – Features of diabetic retinopathy
 Irvine-Gass Syndrome – Optic disc edema

15. Laboratory Inv.
 Guided by suspected etiology
 Fasting blood sugar
 Blood pressure monitoring
 Lipid Profile
 Further work- up for hypercoaguable state

16. Imaging Studies
 Fundus Flourescein Angiography (FFA)
 Late phase showing
central macular leakage
in cystic spaces around
the fovea

17. Imaging Studies
 Optical Coherence Tomography(OCT)
 OCT showing central
macular cystic spaces in
cross -section

18. Treatment – Medical Care
 Topical and systemic NSAID’s – Inhibit
cycloxygenase
 Diclofenac, Ketorolac, Nepafenac eyedrops
 Administered 3 times a day for 3-4 months
 Steroids – Inhibit phospholipase
 Topical/Oral/Intra-vitreal/Sub-tenon
 However, many side-effects

19. Treatment-Medical Care
 Carbonic Anhydrase Inhibitors- enhance the
pumping action of RPE cells
 Oral Acetazolamide 250 mgs 3-4 times a day
 Anti –VEGF Therapy –VEGF known mediator
of capillary leakage
 Intra-vitreal Bevacizumab

20. Treatment-Surgical Care
 Pars Plana Vitrectomy
 Indications
 Remove vitreous strands stuck to pupil after
complicated cataract surgery/trauma
 Peeling of Epiretinal membrane
 Peeling of posterior hyaloid face in vitreo-
macular traction syndrome
 Unresponsive to medical treatment

21. Prevention
 Avoid intra-ocular complications
 Post. Capsule tear/Vitreous loss/Dislocated
lens fragments/ IOL capture/Iris prolapse

22. Prevention
 Pre-operative NSAIDS decrease the incidence
of CME after Cataract Surgery

23. Course and Prognosis
 Most cases resolve with treatment
 Pseudophakic CME has the best prognosis
 However, if persistent or multiple remissions
or exacerbations, leads to irreversible
photoreceptor damage and vision loss