✍️common pathological response to a wide variety of ocular insults, most commonly after cataract surgery (Irvine Gass syndrome)
✅Cystoid macular oedema Causes:
✍️ Inflammatory disorders
☝️ Post-operative (cataract/corneal/vitreoretinal surgery).
☝️ Post-laser (peripheral iridotomy, PRP).
☝️ Post-cryotherapy.
☝️ uveitis.
✍️ Retinal vascular disease
☝️ RVO.
☝️ Diabetic retinopathy.
☝️ Hypertensive retinopathy.
☝️ Radiation retinopathy.
☝️ OIS.
☝️ Retinal vascular telangiectasia
✍️ Choroidal vascular disease
☝️ CNV.
✍️ Drug induced
☝️ nicotinic acid.
☝️ Topical adrenaline.
☝️ Prostaglandin analogues (latanoprost).
☝️ Chemotherapeutic agents (paclitaxel).
☝️ Glitazones.( oral anti DM)
✍️ Inherited retinal dystrophies
☝️ RP.
☝️ Autosomal dominantly inherited CMO.
✍️ Disorders of vitreoretinal interface
☝️ Vitreomacular traction syndrome.
☝️ ERM.
✍️ Optic nerve head abnormalities
☝️ Optic disc pit.
☝️ Optic disc coloboma.
✍️ Tumours of the choroid/retina.
✍️ Idiopathic.
✅Cystoid macular oedema Mechanisms:
✍️ Increased vascular permeability
✍️ Release of hyperpermeability factors
☝️ VEGF
☝️ prostaglandins
✍️ Loss of vascular structure
☝️ loss of endothelial cells
☝️ loss of pericytes in diabetic retinopathy
✍️ Congenital vascular abnormalities
☝️ Coats’ disease
✍️ Increased blood flow
☝️post-operative states.
✍️ Dysfunction of the RPE barrier or pump
☝️ inherited retinal dystrophies.
✍️ Tractional stress
☝️ vitreomacular traction
☝️ ERM .
✍️ Drug reactions.
✍️ Fluid migration from abnormalities of the optic nerve head
☝️ optic disc pit .
☝️ optic disc coloboma
✅Cystoid macular oedema Clinical picture:
✍️ may be Asymptomatic
✍️ symptomatic
☝️ dropped VA (may be severe)
☝️ metamorphopsia
☝️ central scotomas.
✍️ signs
☝️ Loss of foveal contour
☝️ retinal thickening
☝️ cystoid spaces
☝️ central yellow spot
☝️ small intraretinal haemorrhages
☝️ telangiectasia (occasional).
✍️ Associated features depend on the underlying cause.
✍️ Complications
☝️ lamellar hole (irreversible dropped VA).
✅Cystoid macular oedema Investigations:
✍️ FFA
☝️ typically dye leakage from the parafovea into the cystoid spaces (petalloid pattern) and from the optic disc.
☝️ CMO may develop in the absence of retinal capillary leakage on FFA (certain drug reactions and inherited dystrophies).
✍️ OCT
☝️ detection rate is equal to FFA
☝️ measure degree of retinal thickening
☝️ detect vitreomacular traction.
☝️ differentiating CMO from macular retinoschisis (XLRS).
✅Cystoid macular oedema Treatment:
✍️ variable according to the underlying cause and severity
✍️ a step-wise approach is highly recommended.
✍️ Most experts would proceed directly to local or systemic therapy, unless the CMO is related to a recent insult (such as surgery or laser).
✍️ Review the diagnosis if atypical or slow to respond.
✍️ your stepwise approach
☝️ Topical (if CMO related to a recent insult)
• steroid (dexamethasone 0.1% 4×/d)
• NSAID (ketorolac 0.3% 3×/d).
☝️ Review in 4–6wk , if persisting
• Periocular steroid injection orbital floor or sub-Tenon’s ( methylprednisolone or triamcinolone)
• continue topical Steroids and NSAIDs .
☝️ Review in 4–6wk, if persisting
• repeat periocular
• intravitreal steroid (triamcinolone 2mg)
• Anti VEGF in vascular causes
• laser in Diabetic CSME
• Intravitreal implant ( Ozurdex)
• vitrectomy
• systemic steroids (prednisolone 40mg 1×/d, titrating over 3wk or IV methyl prednisolone 500mg single dose) , uveitic CMO may require higher doses
• topical or oral carbonic anhydrase inhibitors (dorzolamide, acetazolamide with limited evidence).
