2020–2021 BCSC Basic and Clinical Science Course™
12 Retina and Vitreous
Part III: Selected Therapeutic Topics
Chapter 20: Vitreoretinal Surgery and Intravitreal Injections
Vitrectomy for Posterior Segment Complications of Anterior Segment Surgery
Cystoid Macular Edema
Cystoid macular edema (CME) that develops after anterior segment surgery usually resolves spontaneously. Treatment with corticosteroid and nonsteroidal anti-inflammatory eye drops is the first-line approach for patients with persistent CME. Periocular or intravitreal corticosteroids may be used in recalcitrant cases. Oral acetazolamide may also be useful in some cases. Pars plana vitrectomy with removal of obvious vitreous adhesions to anterior segment structures may promote resolution of CME and improve visual acuity in select cases (Fig 20-10). An IOL may require repositioning, exchange, or removal if it is deemed that the IOL is irritating the iris by chafing or capture.
Figure 20-10 Fundus photographs of pseudophakic cystoid macular edema (CME). A, Patient has nonresolving CME, vitreous strands adhering to the cataract wound, and a dislocated intraocular lens (IOL). B, Same patient after pars plana vitrectomy, removal of vitreous strands, repositioning of IOL, and periocular administration of corticosteroids. CME has markedly improved.
(Courtesy of Harry W. Flynn, Jr, MD.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.