CYSTOID MACULAR EDEMA

Cystoid macular edema (CME) is

• Characterized by intraretinal edema contained in honeycomb-like cystoid spaces

• FA – Abnormal perifoveal retinal capillary permeability – Multiple Focal fluorescein leaks and late pooling of the dye in

Extracellular Cystoid Spaces

• OCT– DIFFUSE RETINAL THICKENING (RED) with cystic areas of low

reflectivity (reduced reflectivity) more prominently in Inner nuclear and Outer Plexiform layers (INOP)

– Non-reflective cavity can be found in underneath the neurosensory

PETALLOID PATTERN

• Because of the radial foveal arrangement of both glia and Henle inner fibers, this classically forms a flower-petal pattern

CME

• Severe cases may be associated with vitritis(vitreous cells) and on swelling

CMEDisease Entities and Procedures

• Branch Retinal Vein Occlusion

• Central Retinal Vein Occlusion

• Cataract Extraction • Cryopexy• Choroidal

Neovascularization• Choroidal Hemangioma• Diabetic Retinopathy • Glaucoma Procedures

• Photocoagualtion• Prostaglandin Analogs• Retinitis Pigmentosa• RD SURGERY• Uveitis• Vitrectomy

IRVINE GASS SYNDROME

• CME after Cataract surgery– ICCE 60%– ECCE does not appear to increase CME– 6-10 weeks after cataract surgery – Spontaneous resolution -95% in 6 months

• Most cases are mild and asymptomatic • Clinical or symptomatic is the term when only apparent at FA

(angiographic CME)

• Incidence Increases with significant P Uveitis and w/ surgical complications such as – Vit Loss and – Iris Prolapse

• Incidence also Inc. in IOL comlications and Photic Effects

Therapy for CME

• Inflammation is undoubtedly important!

– As evidenced by clinical and pathologic association with

• Vitritis

• Iritis

• Cyclitis

• Retinal Phlebitis

• Other association

– Hypertention, DM, Age >60

CME• High rate of Spontaneous resolution

– Treat or not to Treat?!

• Reasonable to tx px with intraocular evidence of inflammation.

– Considered and used as Prophylaxis

» Topical and systemic NSAID (indomethacin) is effective in reducing incidence of angiographic CME

» PG inhibitors, CAI’s (enhanced fluid transport across RPE)

» Corticosteroids –beneficial for established CME

• Recurrence is high ff cessation

– Established edema