Cystoid macular edema (CME) is a primary cause of
reduced vision following both
cataract and successful
vitreoretinal surgery. The incidence of clinical CME following modern
cataract surgery is 0.1-2.35%. Preexisting conditions such as
diabetes mellitus and
uveitis as well as
intraoperative complications can raise the risk of developing CME postoperatively. The etiology of CME is not completely understood. Prolapsed or incarcerated vitreous and postoperative inflammatory processes have been proposed as causative agents. Pseudophakic CME is characterized by poor postoperative visual acuity.
Fluorescein angiography is indispensable in the workup of CME, showing the classical perifoveal petaloid staining pattern and late leakage of the optic disk. Optical coherence tomography is a useful diagnostic tool, which displays cystic spaces in the outer nuclear layer. The most important differential diagnoses include
age-related macular degeneration and other causes of CME such as diabetic
macular edema. Most cases of pseudophakic CME resolve spontaneously. The value of prophylactic treatment is doubtful. First-line treatment of postsurgical CME should include topical nonsteroidal anti-inflammatory drugs and
corticosteroids. Oral
carbonic anhydrase inhibitors can be considered complementary. In cases of resistant CME, periocular or intraocular
corticosteroids present an option.
Antiangiogenic agents, though experimental, should be considered for nonresponsive persistent CME. Surgical options should be reserved for special indications.