Cystoid macular edema, or CME, often occurs after cataract surgery and intraocular lens implantation. In this condition, fluid-filled cysts form in the macula, causing retinal swelling and blurry vision. Following cataract surgery, CME can develop after a period of clear vision. Although the condition might occur in any patient, certain ones are at higher risk, like patients with diabetes. CME often goes away over time, but there are various treatments available for those patients whose CME does not improve on its own.
Non-Steroidal Anti-Inflammatory Drugs
Non-steroidal anti-inflammatory drugs, or NSAIDs, are often used preemptively to avoid cystoid macular edema because inflammation caused by prostaglandins is thought to be the cause of CME. Eric D. Donnenfeld, M.D., explains in "Retina Today" that NSAIDs only inhibit the production of prostaglandins and do not address those already formed, thus a surgeon will often prescribe NSAID eye drops to the patient for several days before cataract surgery to lower the risk of developing CME. If CME does develop after cataract surgery, the eye surgeon might still choose to prescribe NSAID eye drops in an attempt to treat the condition. Since NSAID eye drops can enter the eye at higher levels than their oral counterparts, NSAID eye drops seem to work better than oral NSAIDs.
Corticosteroid Eye Drops
Corticosteroids appear to interact with the prostaglandin mechanisms that cause inflammation as well, so steroid eye drops can be used along with the NSAID eye drops. Oral steroid treatment has not been proven to work in CME, therefore steroid pills are not usually prescribed.
Injected Steroids
If topical medications do not improve the condition in a few months, the eye doctor may decide to inject a dose of steroids around the back of the eye, notes Vincent J. Patalano II, M.D., in the "Digital Journal of Ophthalmology." If this does not improve the vision, a dose of steroids may be injected into the eye as well. The doctor will monitor these patients closely because the steroids may cause glaucoma.
Vitrectomy
For patients with CME that does not improve, Patalano indicates that some eye surgeons perform a vitrectomy. In vitrectomy surgery, the vitreous--that is, the jelly-like substance in the rear of the eye--is removed through small instruments placed in the eye. This surgery is typically performed by retina specialists.
Cancer Medications
Donnenfeld reports that some retina specialists are injecting an oncology medication, a vascular endothelial growth factor inhibitor, into the vitreous to treat the macular edema. Vascular endothelial growth factor inhibitors were originally used to treat cancers but have been found to have other uses. For the time being, this treatment option is used when other therapies are unsuccessful and is also typically performed by retina specialists.
References
- University of Michigan Kellogg Eye Center: Cystoid Macular Edema
- Digital Journal of Ophthalmology: The Risks and Benefits of Cataract Surgery
- "Ophthalmology"; Intravitreal Bevacizumab for Refractory Pseudophakic Cystoid Macular Edema: The Pan-American Collaborative Retina Study Group Results; J. F. Arevalo et al.; August 2009
- "Retina Today"; CME From the Anterior Segment Surgeon’s Perspective; E. D. Donnenfeld, M.D.; November/December 2008
