Controversies in the management of Irvine-Gass syndrome

Abstract

Severe postoperative cystoid macular edema associated with posterior uveitis, commonly referred to as Irvine-Gass syndrome, may occur after intraocular surgery and result in visual loss. There is little consensus on the efficacy of various topical, peribulbar, retrobulbar, or intravitreal therapeutic options compared to natural history, but patients with this condition are often referred to retinal specialists for treatment consultation. Whether you practice in a multispecialty or retina-only practice, postoperative “surprises” including visual acuity that does not meet patient expectations or decreased vision several weeks or months after anterior segment surgery often result in a retinal consultation to evaluate for macular pathology. With increasing numbers of patients paying out-of-pocket expenses for premium IOLs, intraoperative aberrometry and laser-assisted cataract surgery, patient expectations are at an all-time high, and as a retinal consultant, you may influence the patient’s final satisfaction level with the referring ophthalmologist. When examination and testing reveal macular edema, the treating physician must recognize the etiology of the edema and also understand and be able to explain all possible treatment options. In my practice, all patients referred from my anterior segment colleagues for “blurred vision” shortly after surgery require a careful history and review of preoperative exam findings. Did the patient have preoperative optical coherence tomography (OCT) testing? If, for example, there is a thick epiretinal membrane discovered after surgery, patients will often ask, “Why wasn’t this discovered before surgery?” In this case, it is important to defend your referral sources and explain that visualization of the retinal pathology was limited prior to cataract surgery. A brunescent Controversies in the management of Irvine-Gass syndrome