Abstract
Cataract surgery is an efficient procedure, and is generally associated with good visual results. Nevertheless, cystoid macular edema (CME) may develop, and this can result in suboptimal postoperative vision. Many factors are considered to contribute to its development, and although the treatment options depend upon the underlying cause of CME, the usual therapeutic approach for prophylaxis and treatment of CME is directed towards blocking the inflammatory mediators. This article provides a review of possible risk factors, pathogeneses, incidence rates, and methods of diagnosis, as well as the current guidelines for managing CME.
References
1.
DeCross FC, Afshari NA: Perioperative antibiotics and anti-inflammatory agents in cataract surgery. Curr Opin Ophthalmol 2008;19:22–26.
2.
Panchapakesan J, Rochtchina E, Mitchell P: Five-year change in visual acuity following cataract surgery in an older community: the Blue Mountains Eye Study. Eye 2004;18:278–282.
3.
Linebarger EJ, Hardten DR, Shah GK, et al: Phacoemulsification and modern cataract surgery. Surv Ophthalmol 1999;44:123–147.
4.
Gogate PM, Kulkarni SR, Krishnaiah S, et al: Safety and efficacy of phacoemulsification compared with manual small-incision cataract surgery by a randomized controlled clinical trial: six-week results. Ophthalmology 2005;112:869–874.
5.
Riaz Y, Mehta JS, Wormald R, et al: Surgi- cal interventions for age related cataract. Cochrane Database Syst Rev 2006;(4): CDOOI323.
6.
O‘ Brien TP: Emerging guidelines for use of NSAD therapy to optimize cataract surgery patient care. Curr Med Res Opin 2005;21:1131–1137, correction 2005;21:1431–1432.
7.
Rossetti L, Autelitano A: Cystoid macular edema following cataract surgery. Curr Opin Ophthalmol 2000;11:65–72.
8.
Mohammadpour M, Jafarinasab MR, Javadi MA: Outcomes of acute postoperative inflammation after cataract surgery. Eur J Ophthalmol 2007;17:20–28.
9.
Nelson ML, Martidis A: Managing cystoid macular edema after cataract surgery. Curr Opin Ophthalmol 2003;14:39–43.
10.
Irvine AR: A newly defined vitreous syndrome following cataract surgery, interpreted according to recent concepts of the structure of the vitreous. Am J Ophthalmol 1953;36:599–619.
11.
Gass JD. Norton EW: Cystoid Macular edema and papilledema following cataract extraction: a fluorescein fundoscopic and angiographic study. Arch Ophthalmol 1966;76:646–661.
12.
Irvine AR: Cystoid maculopathy. Surv Ophthalmol 1976;21:1–17.
13.
Ursell PG, Spalton DJ, Whitcup SM, Nussenblat RB: Cystoid macular edema after phacoemulsification: relationship to blood-aqueous barrier damage and visual acuity. J Cataract Refract Surg 1999;25:1492–1497.
14.
Hitchings RA, Chisholm IH, Bird AC: Aphakic macular edema: incidence and pathogenesis. Invest Ophthalmol Soc 1975;14:68–72.
15.
Jaffe NS, Clayman HM, Jaffe MS: Cystoid macular edema after intracapsular and extracapsular extraction with and without an intraocular lens. Ophthalmology 1982;89:25–29.
16.
Kraff MC, Sanders DR, Jampol LM, Lieberman HL: Effect of primary capsulotomy with extracapsular surgery on the incidence of pseudophakic cystoid macular edema. Am J Ophthalmol 1984;98:166–170.
17.
Koch PS: Anterior vitrectomy; in Nordan LT, Maxwell WA, Davidson JA (eds): Surgical Rehabilitation of Vision: An Integrated Approach to Anterior Segment Surgery. London, Gower, 1992, chapter 17.
18.
Powe NR, Schein OD, Gieser SC, et al: Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team. Arch Ophthalmol 1994;112:239–252.
19.
Oshika T, Yoshimura K, Miyata N: Postsurgical inflammation after phacoemulsification and extracapsular extraction with soft or conventional intraocular lens implantation. J Cataract Refact Surg 1992;18:356–361.
20.
Pande MV, Spalton DJ, Kerr-Muir MG, Marshall J: Postoperative inflammatory response to phacoemulsification and extracapsular cataract surgery: aqueous flare and cells. J Cataract Refract Surg 1996;22:770–774.
21.
Kraff MC, Lieberman HL, Jampol LM, Sanders DR: Effect of a pupillary light occluder on cystoid macular edema. J Cataract Refract Surg 1989;15:658–660.
22.
Nagpal M, Nagpal K, Nagpal PN: Postcataract cystoid macular edema. Ophthalmol Clin North Am 2001;14:651–659.
23.
Stern AL, Taylor DM, Dalburg LA, et al: Pseudophakic cystoid maculopathy: a study of 50 cases. Ophthalmology 1981;88:942–946.
24.
Loewenstein A, Zur D: Postsurgical cystoid macular edema; in Coscas G (ed): Macular Edema. Dev Ophthal. Basel, Karger, 2010; vol 47, pp 148–159.
25.
Frost NA, Sparrow JM, Strong NP, Rosenthal AR: Vitreous loss in planned extracapsular cataract extraction does lead to a poorer visual outcome. Eye 1995;9:446–451.
26.
Flach AJ: The incidence, pathogenesis and treatment of cystoid macular edema following cataract surgery. Trans Am Ophthalmol Soc 1998;96:557–634.
27.
Balent A, Civerchia LL, Mohamadi P: Visual outcomes of cataract extraction and lens implantation complicated by vitreous loss. J Cataract Refract Surg 1988;14:158–160.
28.
Bergman M, Laatikainen L: Cystoid macular oedema after complicated cataract surgery and implantation of an anterior chamber lens. Acta Ophthalmol (Copenh) 1994;72:178–180.
29.
Blomquist PH, Rugwani RM: Visual outcomes after vitreous loss during cataract surgery performed by residents. J Cataract Refract Surg 2002;28:847–852.
30.
Ah-Fat FG, Sharma MK, Majid MA, Yang YC: Vitreous loss during conversion from conventional extracapsular cataract extraction to phacoemulsification. J Cataract Refract Surg 1998;24:801–805.
31.
Morel C, Roman S, Metge F, et al: Surgery of intravitreous nuclear luxations post-phacoemulsification (in French). J Fr Ophthalmol 1998;21:170–175.
32.
Ray S, Amico DJ: Pseudophakic cystoid macular edema. Semin Ophthalmol 2002;17:167–180.
33.
Spaide RF, Yannuzzi LA, Sisco LJ: Chronic cystoid macular edema and predictors of visual acuity. Ophthalmic Surg 1993;24:262–267.
34.
Borne MJ, Tasman W, Regillo C, et al: Outcomes of vitrectomy for retained lens fragments. Ophthalmology 1996;103:971–976.
35.
Kapusta MA, Chen JC, Lam WC: Outcomes of dropped nucleous during phacoemulsification. Ophthalmology 1996;103:1184–1187.
36.
Rossetti A, Doro D: Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. J Cataract Refract Surg 2002;28:310–315.
37.
Cohen SM, Davis A, Cukrowski C: Cystoid macular edema and pars plana vitrectomy for retained lens fragments. J Cataract Refract Surg 2006;32:1521–1526.
38.
Sheidow TG, Gonder JR: Cystoid macular edema following combined phacoemulsification and vitrectomy in macular hole. Retina 1998;18:510–514.
39.
Jampol LM: Aphakic cystoid macular edema: a hypothesis. Arch Ophthalmol 1985;103:1134–1135.
40.
Callanan D, Fellman RL, Savage JA: Latanoprost-associated cystoid macular edema. Am J Ophthalmol 1998;126:134–135.
41.
Miyake K, Ota I, Maekubo K, et al: Latanoprost accelerates disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema in early postoperative pseudophakias. Arch Ophthalmol 1999;117:34–40.
42.
Moroi SE, Gottfredsdottir MS, Schteingart MT, et al: Cystoid macular edema associated with latanoprost therapy in a case series of patients with glaucoma and ocular hypertension. Ophthalmology 1999;106:1024–1029.
43.
Ayyala RS, Cruz DA, Margo CE, et al: Cystoid macular edema associated with latanoprost in aphakic and pseudophakic eyes. Am J Ophthalmol 1998;126:602–604.
44.
Wand M, Gaudio AR: Cystoid macular edema associated with ocular hypotensive lipids. Am J Ophthalmol 2002;133:403–405.
45.
Pollack A, Leiba H, Bukelman A, Oliver M: Cystoid macular edema following cataract extraction in patients with diabetes. Br J Ophthalmol 1992;76:221–224.
46.
Schmier JK, Halpern MT, Covert DW, et al: Evaluation of cost for cystoid macular edema among patients after cataract surgery. Retina 2007;27:621–628.
47.
Henricsson M, Heijl A, Janzon L: Diabetic retinopathy before and after cataract surgery. Br J Ophthalmol 1996;80:789–793.
48.
Dowler JGF, Hykin PG, Lightman SL, et al: Visual acuity following extracapsular cataract extraction in diabetes: a meta-analysis. Eye 1995;9:313–317.
49.
Schatz H, Atienza D, McDonald HR, et al: Severe diabetic retinopathy after cataract surgery. Am J Ophthalmol 1994;117:314–321.
50.
Dowler JGF, Sehmi KS, Hykin PG, et al: The natural history of macular edema after cataract surgery in diabetes. Ophthalmology 1999;106:663–668.
51.
Okhravi N, Lightman SL, Towler HM: Assessment of visual outcome after cataract surgery in patients with uveitis. Ophthalmology 1999;106:710–722.
52.
Hooper PL, Rao NA, Smith RE: Cataract extraction in uveitis patients. Surv Ophthalmology 1990;35:120–144.
53.
Foster RE, Lowder CY, Meisler OM, Zakov ZN: Extracapsular cataract extraction and posterior chamber intraocular lens implantation in uveitis patients. Ophthalmology 1992;99:1234–1241.
54.
Schepens CL, Avila MP, Jalkh AE, et al: The role of vitreous in cystoid macular edema. Surv Ophthalmol 1984;28:499–504.
55.
Cunha-Vaz JG, Travassos A: Breakdown of the blood-retinal barriers and cystoid macular edema. Survey Ophthalmol 1984;28:485–492.
56.
Miyake K: Vitreous fluorophotometry in aphakic or pseudophakic eyes with persistent cystoid macular edema. Jpn J Ophthalmol 1985;29:146–152.
57.
Smith RT, Campbell CJ, Koester CJ, et al: The barrier function in extracapsular cataract surgery. Ophthalmology 1990;97:90–95.
58.
Miyake K: Prevention of cystoid macular edema after lens extraction by topical indomethacin. I. A preliminary report. Albrecht von Grafes Arch Klin Exp Ophthalmol 1977;203:81–88.
59.
Miyake K: Prevention of cystoid macular edema after lens extraction by topical indomethacin. II. A control study in bilateral extractions. Jpn J Ophthalmol 1978;22:80–94.
60.
Jampol LM: Cystoid macular edema following cataract surgery. Arch Ophthalmol 1988;106:894–895.
61.
Stark WJ, Maumenee AE, Fagadau W, et al: Cystoid macular edema in pseudophakia. Surv Ophthalmol 1984;28:442–445.
62.
Bito LZ: Prostaglandins: old concepts and new perspectives. Arch Ophthalmol 1987;105:1036–1039.
63.
Tso MOM: Pathophysiology of cystoid macular edema. Ophthalmology 1982;89:902–915.
64.
Miyake K, Ibaraki N: Prostaglandins and cystoid macular edema. Surv Ophthalmol 2002;47(suppl 1):S203–S218.
65.
Augustin A, Loewenstein A, Kuppermann BD: General pathophysiology; in Coscas G (eds): Macular Edema. Dev Ophthalmol. Basel, Karger, 2010, vol 47, pp 10–26.
66.
Mentes J, Erakgun T, Afrashi F, et al: Incidence of cystoid macular edema after uncomplicated phacoemulsification. Ophthalmologica 2003;217:408–412.
67.
Asano S, Kensaku M, Ota I, et al: Reducing angiographic cystoid macular edema and blood-aqueous barrier disruption after small-incision phacoemulsification and foldable intraocular lens implantation. Multicenter prospective randomized comparison of topical diclofenac 0.1% and betamethasone 0.1%. J Cataract Refract Surg 2008,34:57–63.
68.
Rossetti L, Chaudhwi H, Dickersin K: Medical prophylaxis and treatment of cystoid macular edema after cataract surgery: the results of a meta-analysis. Ophthalmology 1998;105:397–405.
69.
Sivaprasad S, Bunce C, Wormald R: Nonsteroidal anti-inflammatory agents for cystoid macular oedema following cataract surgery: a systematic review. Br J Ophthalmol 2005;89:1420–1422.
70.
Kraff MC, Sanders DR, Jampol LM, et al: Factors affecting pseudophakic cystoid macular edema: five randomized trials. J Am Intraoc Implant Soc 1985;11:380–385.
71.
Henderson BA, Kim JY, Ament CS, et al: Clinical pseudophakic cystoid macular edema: risk factors for development and duration after treatment. J Cataract Refract Surg 2007;33:1550–1558.
72.
Kim A, Stark WJ: Are topical NSAIDs needed for routine cataract surgery? Am J Ophthalmol 2008;146:554–560.
73.
Arciere ES, Santana A, Rocha FN: Blood-aqueous barrier changes after the use of prostaglandins analogues in patients with pseudophakia and aphakia. Arch Ophthalmol 2005;123:186–192.
74.
Lobo CL, Faria PM, Soares MA, et al: Macular alterations after small incision cataract surgery. J Cataract Refract Surg 2004;30:752–760.
75.
Hee MR, Izatt JA, Swanson EA, et al: Optical coherence tomography of the human retina. Arch Ophthalmol 1995;113:325–332.
76.
Perente I, Utine CA, Ozturker C, et al: Evaluation of macular changes after uncomplicated phacoemulsification surgery by optical coherence tomography. Curr Eye Res 2007;32:241–247.
77.
Biro Z, Balla Z, Kovacs B: Change of foveal and perifoveal thickness measured by OCT after phacoemulsification and IOL implantation. Eye 2008;22:8–12.
78.
Almeida DR, Johnson D, Hollands H, et al: Effect of prophylactic nonsteroidal anti-inflammatory drugs on cystoid macular edema assessed using optical coherence tomography quantification of total macular volume after cataract surgery. J Cataract Refract Surg 2008;34:64–69.
79.
Salomon LD: Efficacy of topical flurbiprofen and indomethacin in preventing pseudophakic cystoid macular edema. Flurbiprofen – CME study group I. J Cataract Refract Surg 1995;21:73–81.
80.
Cervantes-Costes G, Sánchez-Castro Y, Mendoza-Schuster E, et al: Inhibition of surgically induced miosis and prevention of postoperative macular edema with nepafenac. Clin Ophthalmol 2009;3:219–226.
81.
Wolf EJ, Braunstein A, Shih C, et al: Incidence of visually significant pseudophakic macular edema after uneventful phacoemulsification in patients treated with nepafenac. J Cataract Refreact Surg 2007;33:1546–1549.
82.
Heier JS, Topping TM, Baumann W, et al: Ketorolac versus prednisolone versus combination therapy in treatment of acute pseudophakic cystoid macular edema. Am Acad Ophthalmology 2000;107:2034–2038.
83.
Flach AJ: Nonsteroidal anti-inflammatory drugs; in Tasman W (ed): Duane’s Foundations of Clinical Ophthalmology. Philadelphia, Lippincott, 1994, pp 1–32.
84.
Jonas JB, Kreissing I, Segenring RF: Intravitreal triancinolone acetonide for pseudophakic cystoid macular edema. Am J Ophthalmol 2003;136:384–386.
85.
Boscia F, Furino C, Dammaco R, et al: Intravitreal triancinolone acetonide in refractory pseudophakic cystoid macular edema: functional and anatomic results. Eur J Ophthalmol 2005;15:89–95.
86.
Conway MD, Canakis C, Livir-Rallatos C, et al: Intravitreal triancinolone acetonide for refractory chronic pseudophakic cystoid macular edema. J Cataract Refract Surg 2003;29:27–33.
87.
Tranos PG, Wickremasinghe SS, Stangos NT, et al: Macular edema. Surv Ophthalmol 2004;5:470–490.
88.
Catier A, Tadayoni R, Massin P, et al: Advantages of acetazolamide associated with anti-inflammatory medications in postoperative treatment of macular edema (in French). J Fr Ophthalmol 2005;28:1027–1031.
89.
Spitzer MS, Ziemssen F, Yoeruek E, et al: Efficacy of intravitreal bevacizumab in treating postoperative pseudophakic cystoid macular edema. J Cataract Refract Surg 2008;34:70–75.
90.
Steinert RF, Wasson PI: Neodymium: YAG laser anterior vitreolysis for Irvine-Gass cystoid macular edema. J Cataract Refract Surg 1989;15:304–307.
91.
Alió J, Bodaghi B, Tassignon MJ: Guidelines for managing post-cataract surgery inflammation. Can we reach a consensus? Ophthalmol Times Europe 2008;(suppl Nov):1–11.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.