Contents
Macular edema characterized by the formation of radially oriented multiple cyst-like spaces within the neurosensory retina.
- Macular edema: Swelling/thickening of neurosensory retina within the macular region, resulting from fluid collection within/below the retina
- M/C cause of decreased vision postoperatively in uneventful cataract surgery
Aetiology
CME is the common pathologic sequel of the retina and occurs in a variety of pathological conditions such as intraocular inflammation, central or branch retinal vein occlusion, diabetic retinopathy and most commonly following cataract extraction.
- Inflammatory disorders: intraocular surgery, uveitic syndromes, laser procedures
- Irvin-Gass syndrome: Cystoid macular edema (CME) following cataract surgery
- Retinal vascular disease (M/C causes): diabetic retinopathy, retinal vein occlusion, hypertensive retinopathy
- Choroidal vascular disease: choroidal neovascularization
- Tractional maculopathies: epiretinal membrane, vitreomacular traction syndromes
- Drug reactions: epinephrine, prostaglandin analogs, nicotinic acid, tamoxifen, glitazones
- Inherited retinal dystrophies: retinitis pigmentosa
- Retinal detachment: exudative, rhegmatogenous
- Intraocular tumors: choroidal melanoma
- Optic nerve head abnormalities: diabetic/hypertensive papillopathy, neuroretinitis, optic nerve pits/colobomas
- Idiopathic
Pathophysiology
Caused by a break caused cystic accumulation of intraretinal fluid in the outer plexiform and inner nuclear layers of the retina as a result of the breakdown of the blood–retinal barrier

Diagnosis
Fluorescein angiography (FA):
- Flower petal pattern (d/t accumulation of dye in outer plexiform layer at fovea)

Optical coherence tomography (OCT):

Management
Anti-inflammatory agents:
Mainstay treatment of postoperative and uveitic CME
- Topical corticosteroids:
- Difluprednate
- Loteprednol etabonate
- Prednisolone acetate
- Rimexolone
- Topical NSAIDs:
- Ketorolac
- Diclofenac
- Nepafenac
- Bromfenac
Posterior sub-Tenon steroid injections:
Resistant cases of postoperative CME and most cases of uveitic CME
Systemic corticosteroids:
Reserved for bilateral CME complicating noninfectious uveitis
Intravitreal steroids:
- Intravitreal triamcinolone acetonide (IVTA)
- Dexamethasone intravitreal drug delivery system (DDS)
Vitrectomy:
Selected cases with chronic inflammatory CME