Title

BILATERAL CYSTOID MACULAR EDEMA AFTER UNILATERAL CATARACT SURGERY

Introduction

Cystoid macular edema (CME) is presented by intraretinal edema in honeycomb cystoid spaces. The source is the peripheral capillary permeability of the peripheroveal retina in a variety of conditions: Diabetes, central retinal vein occlusion, uveitis and any eye surgery. Post-facectomy is the most common cause. Cysts are between the inner nuclear and outer plexiform layers. Patients complain of reduced visual acuity and macular thickening is observed in posterior pole. Complementary exams such as angiofluoresceinography (AFG) and optical coherence tomography (OCT) help the diagnosis. The peak incidence after surgery is in 6-10 weeks. Surgical risks are: vitreous traction, iris imprisonment, IOL mispositioning and posterior capsule rupture. Spontaneous resolution within 6 months in most cases

Methods

A case report with medical record review.

Results

66-year-old female patient, who was undergoing surgical programming for facectomy. She had glaucoma surgery in both eyes (BE). At examination, the best corrected visual acuity (VA) was: Right eye 20/200 and left eye 20/30. Anterior segment presented superior trabeculectomy bubble, bilateral nuclear cataract. IOP was 12 in BE and fundus showed increased papillary excavation. Cataract surgery with IOL implantation in the capsular sac, with VA improvement to 20/40. 5 weeks after surgery she reported low vision. VA was 20/200 and 20/60. Fundus showed macular edema and a thin epirretinal membrane in RE. AFG and OCT showed CME. Topical NSAID was started and after 3 months, OCT showed anatomical improvement. No further interventionist measures were required.

Discussion

We were unable to find, in the reviewed literature, a situation of bilateral occurrence after unilateral surgery. According to case reports in the literature, the occurrence is unilateral, in the same eye in which cataract surgery was performed. In this case, retrospective analysis did not allow to determine the exact mechanism involved in the pathophysiology of the bilateral condition.

Keywords

Bilateral cystoid macular edema, Cataract surgery

Area

CLINICAL CASE

Authors

Lana Martins Menezes, Juliana Abreu Rio, Rafael Cicconi Arantes, Ricardo Luz Leitão Guerra