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
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