Case Of Cystoid Macular Edema Research Articles

RETRACTED ARTICLE: Cystoid Macular Oedema in a Patient Treated with STING Agonist and Ezabenlimab for Disseminated Melanoma.

We describe a case of cystoid macular oedema associated with combination treatment using a STING agonist and ezabenlimab for disseminated melanoma. A 66-year-old male patient presented with worsening vision and cystoid macular oedema in the right eye, along with a small accumulation of subretinal fluid in the left eye. The patient has been undergoing treatment for melanoma since 2014. Five months prior to the ocular presentation, the patient was enrolled in a first-in-human trial with a STING agonist and ezabenlimab. Topical treatment with dexamethasone 0.1% drops and ketorolac 0.5% drops was prescribed, and he continued with systemic immunotherapy. After 6 weeks, morphological and functional improvement was noted; however, cystoid macular oedema persisted. Consequently, systemic immunotherapy was temporarily suspended. After an additional 4 weeks, cystoid macular oedema regressed in the right eye and subretinal fluid completely resolved in the left eye. In the first-in-human trial with a STING agonist and ezabenlimab for melanoma, cystoid macular oedema emerged as a notable ocular side effect with vision worsening. This case highlights the importance of careful ocular monitoring in patients receiving this combination therapy. The cGAS-STING pathway is an important target for future research in treating ocular inflammatory conditions.

Cystoid macular edema associated with omidenepag isopropyl in a phakic eye with an implantable collamer lens: a case report

BackgroundCystoid macular edema is a known complication of omidenepag isopropyl usage. Omidenepag isopropyl is a selective prostanoid EP2 receptor agonist, and its association with macular edema has mainly been identified in pseudophakic eyes. Herein, we report a case of cystoid macular edema caused by omidenepag isopropyl use in a phakic eye with an implantable collamer lens.Case presentationA 38-year-old woman was diagnosed with left eye glaucoma and prescribed omidenepag isopropyl. She had undergone bilateral implantation of implantable collamer lenses approximately 12 years prior to the glaucoma diagnosis. After 9 months of using omidenepag isopropyl, she presented with blurred vision in the left eye; swept source optical coherence tomography revealed cystoid macular edema in this eye. Omidenepag isopropyl usage was discontinued, and bromfenac sodium hydrate was administered twice daily instead. After 2 months, the patient’s visual discomfort was completely ameliorated. Additionally, an optical coherence tomography examination confirmed that the macula had normalized.ConclusionsWe report a case of cystoid macular edema development after omidenepag isopropyl use in a patient with glaucoma who had undergone bilateral implantable collamer lens implantation. This case shows that the possibility of cystoid macular edema occurrence should be considered when omidenepag isopropyl is used, even in phakic eyes, after the insertion of implantable collamer lenses.

INTRAVITREAL DEXAMETHASONE FOR THE TREATMENT OF MACULAR EDEMA SECONDARY TO HYDROXYCHLOROQUINE TOXICITY.

Cystoid macular edema is a vision-threatening complication infrequently associated with hydroxychloroquine retinal toxicity. There are limited data on the best treatment for this pathology. A retrospective case series is presented. In this series, we present three cases of cystoid macular edema in patients with diagnosed hydroxychloroquine maculopathy successfully treated with intravitreal dexamethasone implantation. Minimal literature has been published regarding the best management of cystoid macular edema related to hydroxychloroquine toxicity. Our case series suggests a possible new agent in the treatment of this rare occurrence.

Visual outcomes after vitrectomy for epiretinal membrane in pseudophakic eyes with a diffractive trifocal intraocular lens: a retrospective cohort study

BackgroundDiffractive intraocular lenses (IOLs) could affect visual acuity in patients with macular pathologies such as epiretinal membrane (ERM) and could influence the results of pars plana vitrectomy (PPV) for ERM removal in pseudophakic eyes with these IOLs. The aim of this study is to evaluate the effect on visual outcomes of a diffractive trifocal IOL in PPV for ERM peeling.MethodsThis is a retrospective cohort study on 20 eyes with a single model of trifocal IOL that underwent PPV for removal of ERM between January 2015 and September 2018 in our clinics. Follow up was at least 1 year. Primary outcome measure was mean change in visual acuity. Secondary outcome measures were mean change in central macular thickness (CMT), recovery of the external retinal layers, and change in spherical equivalent (SE).ResultsMean corrected distance visual acuity (CDVA) was 0.03 ± 0.03 logMAR after phacoemulsification; this worsened to 0.23 ± 0.10 logMAR with ERM, improving to 0.10 ± 0.04 log MAR 12 months after PPV (p = 0.001). Mean uncorrected near visual acuity (UNVA) was Jaeger 2.62 ± 0.51 after lensectomy. This worsened to Jaeger 5.46 ± 1.67 with ERM and improved to the initial Jaeger 2.69 ± 0.84 after PPV (p = 0.005). CMT decreased significantly, from 380.15 ± 60.50 μm with the ERM to 313.70 ± 36.98 μm after PPV. Mean SE after lensectomy was − 0.18 ± 0.38 D, which minimally changed to – 0.18 ± 0.47 D after PPV (p = 0.99). The only complication recorded after PPV was a case of cystoid macular edema. No difficulties in visualization due to IOL design were reported during PPV.ConclusionPPV for ERM in eyes with this trifocal IOL seems to be safe and effective, and allows recovery of the loss of UNVA.

Combined phacoemulsification and iStent inject implantation in Asian eyes.

To evaluate the safety and efficacy of the iStent inject device combined with phacoemulsification in Asian eyes with primary open angle glaucoma. A retrospective study of combined phacoemulsification and iStent inject surgeries performed in a single institution from July 2017 to August 2019 on patients with co-existing cataracts and primary open angle glaucoma (POAG). Outcome measures included best-corrected visual acuity, intraocular pressure (IOP), number of glaucoma eyedrop medications, and surgical complications. A total of 95 eyes were included. Majority of subjects were male (59, 62.1%) and Chinese (83, 87.4%). Mean age was 74.7 ± 8.7 years. Pre-operatively, mean IOP was 16.2 ± 4.3 mmHg and number of medications was 1.9 ± 0.9. Significant post-operative reduction in mean IOP was observed at all timepoints - post-operative month (POM)1: 3.0 ± 5.6 mmHg reduction (n = 95, p < 0.05); POM3: 1.6 ± 3.8 mmHg (n = 66, p < 0.05); POM6: 1.8 ± 4.7 mmHg (n = 55, p < 0.05); POM12: 1.3 ± 4.2 mmHg (n = 48) (p < 0.05). The number of glaucoma medications was also reduced from a mean of 1.9 ± 0.8 to 0.6 ± 1.0 at POM12 (p < 0.05). Intraoperatively, one case of malignant glaucoma occurred. Post operatively, implant obstruction by iris was observed in two eyes post-operatively requiring iridoplasty. One case of cystoid macular edema and one case of drop in visual acuity due to glaucoma progression was/were also observed. Asian eyes undergoing combined phacoemulsification and iStent inject surgery demonstrate a significant and sustained reduction in both IOP and number of glaucoma medications. Overall, there is a good safety profile for iStent inject.

Safety and efficacy of custom foldable silicone artificial iris implantation: prospective compassionate-use case series.

To assess the preliminary safety and efficacy of custom silicone artificial iris implantation. Stein Eye Institute. Prospective consecutive case series. Medical records of patients implanted with the artificial iris were reviewed and followed for 1 year. Safety measures included corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell count (ECC), surgical complications, secondary interventions, and adverse events (AEs). Efficacy measures included CDVA with glare, subjective daytime and nighttime glare graded from 0 to 10 (very significant), and subjective cosmetic appearance graded from 0 to 10 (very satisfied). Twenty eyes (19 patients) were implanted. Safety data were mixed. CDVA improved in 13 eyes and worsened in 6. ECC decreased from 1918 ± 870 to 1405 ± 705 cells/mm (P = .02). Eight eyes experienced postoperative complications. There were 4 IOP elevations, 2 corneal decompensations, 1 case of cystoid macular edema, and 1 device dislocation. Four eyes underwent secondary surgical interventions including 2 AEs (1 glaucoma surgery and 1 device dislocation). Efficacy outcomes were excellent. CDVA with glare improved from 1.5 ± 0.6 to 0.7 ± 0.8 logarithm of the minimum angle of resolution (P < .01). Mean subjective daytime glare decreased from 8.9 ± 1.8 to 2.7 ± 2.6 (P < .01) and nighttime glare decreased from 7.9 ± 1.8 to 2.5 ± 2.7 (P < .01). Mean cosmesis improved from 2.2 ± 1.6 to 8.8 ± 2.1 (P < .01). Custom artificial iris implantation was moderately risky but very effective at reducing light and glare sensitivity and in improving ocular cosmesis.

Cystoid Macular Edema after Extracapsular Cataract Extraction Performed by Residents

Purpose: To determine the frequency and outcome of management of cystoid macular edema after extracapsular cataract extraction performed by residents.Study Design: Interventional case series.Place and Duration of Study: Lady Reading Hospital, MTI, Peshawar from Oct 2018 to Oct 2019.Material and Methods: Total 400 patients with mature cataract were included in our study. Patients having preexistingdisease such as uveitis, hypertensive retinopathy, diabetic retinopathy and retinal degenerations wereexcluded. All surgeries were performed by 4th year residents under supervision. Complicated cases before orduring surgery were excluded from the study. Cystoid macular edema cases were classified as follows; acuteoccurring within three months of cataract extraction and with duration fewer than 6 months, chronic persistingmore than 6 months. Patients were either managed conservatively or with anti-VEGF. All cases were followed for3 months or longer until resolution of cystoid macular edema.Results: Twenty patients developed cystoid macular edema out of which 16 patients (80%) improved withconservative treatment and 4 patients (20%) developed resistant cystoid macular edema. All four patients weregiven intravitreal bevacizumab injection monthly for three months. Our findings showed that best corrected visualacuity (BCVA) before injection ranged from 6/60 to 6/24. After three injections BCVA improved between 6/18 to6/6. Pre injection central subfield thickness (CSFT) was between 611 to 480 micron which improved to 272 -260micron after injections.Conclusion: Cystoid macular edema responds well to conservative treatment but resistant cases need repeatedinj of anti VEGF.

Posterior Capsulorhexis for Draining Berger Space

Lens material can be detected behind posterior capsule in case of infusion misdirection syndrome development during phacoemulsification. This condition is associated with Wieger ligament damage. There is no accepted management options for this issue. Authors offer original technique of small diameter (2–3 mm) posterior capsulorhexis performed before IOL implantation for evacuation of infusion fluidics and lens material from Berger space. Safety of new technique was evaluated by OCT images analyzing central foveal thickness in 1 day, 3 weeks and 6 weeks after cataract surgery. There were 3 patients groups: I — uneventful phacoemulsification (10 eyes) (control group); II — phacoemulsification with development of infusion misdirection syndrome and lens material behind posterior capsule without performing posterior capsulorhexis (10 eyes); III — phacoemulsification with development of infusion misdirection syndrome performing posterior capsulorhexis for draining Berger space. There was no significant difference in central foveal thickness between patients groups. There was trend of central foveal thickness increase in 3 weeks after surgery in all groups. Central foveal thickness returns to initial values in 6 weeks after surgery in all patients groups. There was no cases of cystoid macular edema in study. In conclusion, small diameter posterior capsulorhexis technique is useful in clinical practice for evacuation of infusion fluidics and lens material from Berger space before IOL implantation.

Clinical study of lens-induced glaucoma at community health center in India

Background and Objective: It has long been recognized clinically that several forms of glaucoma may occur in association with the formation of cataracts, which are an important cause of secondary glaucoma in the developing world.- These lens-induced glaucomas are a common occurrence in India, hardly surprising in a situation where the incident of cataract cases far exceeds the total number of surgeries performed currently. In the developing world, like India, financial, cultural, and psychosocial barriers to accessing excellent surgical services still exist. There is an ever-increasing backlog of cataract due to the population explosion, increased life expectancy, and low productivity in terms of utilization of the available surgical services. The uptake of eye care services by the rural community has also been sub-optimal in countries like India, where lens-induced glaucomas (LIGs) are a common cause of ocular morbidity. The present study has endeavored to determine the characteristics, risk factors, and their consequences on postoperative visual outcome, intraocular pressure (IOP), including optic disc changes in LIGs. Materials and Methods: This study included 50 cases of different types of LIG, admitted in the wards of the Community Health Center, Bandikui, Dausa, Rajasthan, during the period January–September 2019. All consecutive patients diagnosed as LIG on the basis of clinical symptoms and signs were included. Clinical features included pain, loss of vision, redness of the eye, presence of an intumescent, mature, or hypermature cataract associated with raised IOP of >21 mm Hg. Results: In this study series, it is observed that the most frequent type of LIG was phacomorphic glaucoma (PMG) (64%) followed by PhacoLyticc Glaucoma (PLG) (28.00%). In this study, good visual acuity achieved by cases with phacolytic glaucoma (57.00%) was more than PMG (50.00%) optic disc, at last, follow-up in the affected eyes was normal in the majority (36.00%). There were six cases of cystoid macular edema, and the media was hazy in two cases. Glaucomatous disc damage was found in 52% of cases. Although clinically significant disc damage was found more in PMG (57.7%) than PLG (33.33%). Conclusion: Results have shown that the LIGs were more common in the age group of 60–69 years and in females, good visual acuity can be achieved in lens-induced glaucoma presenting within 2 weeks, with intraocular pressure of

Development of "Predict ME," an online classifier to aid in differentiating diabetic macular edema from pseudophakic macular edema.

Differentiating the underlying pathology of macular edema in patients with diabetic retinopathy following cataract surgery can be challenging. In 2015, Munk and colleagues trained and tested a machine learning classifier which uses optical coherence tomography variables in order to distinguish the underlying pathology of macular edema between diabetic macular edema and pseudophakic cystoid macular edema. It was able to accurately diagnose the underlying pathology in 90%-96% of cases. However, actually using the trained classifier required dedicated software and advanced technical skills which hindered its accessibility to most clinicians. Our aim was to package the classifier in an easy to use web-tool and validate the web-tool using a new cohort of patients. We packaged the classifier in a web-tool intended for use on a personal computer or mobile phone. We first ensured that the results from the web-tool coincide exactly with the results from the original algorithm and then proceeded to test it using data of 14 patients. The etiology was accurately predicted in 12 out of 14 cases (86%). The cases with diabetic macular edema were accurately diagnosed in 7 out of 7 cases. Of the pseudophakic cystoid macular edema cases, 5 out of 6 were correctly interpreted and 1 case with a mixed etiology was interpreted as pseudophakic cystoid macular edema. Variable input was reported to be easy and took on average 7 ± 3 min. The web-tool implementation of the classifier seems to be a valuable tool to support research into this field.

Primary care in South Wales

Andy Britton, whose Specsavers practice in Haverfordwest won last year's Optician Award for Enhanced Optical Services, starts another series of recent cases he has managed in primary care with a case of cystoid macular oedema

Cystoid macular oedema associated with Rosai\u2013Dorfman disease: a case report

BackgroundThe aim of this study is to report a case of cystoid macular oedema (CME) associated with Rosai–Dorfman Disease (RDD).Case presentationA 52-year-old male initially presented with a two-month history of a congested left eye. At presentation, visual acuity was 20/20 in the right eye and 20/80 in the left eye. Biomicroscopy showed conjunctival hyperaemia in the left eye with a slight elevation, suggesting a subconjunctival mass. Retinal fluorescein angiography and optical coherence tomography (OCT) revealed the presence of CME in the left eye. A clinical examination revealed nodular lesions in the ears and a lump in the subcutaneous tissue of the left arm. A biopsy of the subcutaneous lesion showed histological and immunohistochemical characteristics of RDD. The patient was treated with intravitreal triamcinolone (0.1 mL/4 mg). One month after treatment, there was complete regression of the oedema with a significant improvement in visual acuity to 20/20.ConclusionsThis is the first reported case of RDD associated with cystoid macular oedema. Macular oedema responded to intravitreal treatment with triamcinolone.

VITREORETINAL COMPLICATIONS AFTER PENETRATING KERATOPLASTY.

To evaluate the time, incidence, and visual outcome of vitreoretinal complications after penetrating keratoplasty (PK). A retrospective chart review of 1,594 eyes that underwent PK was conducted. Preoperative characteristics, visual significance, and postoperative vitreoretinal complications were analyzed. The incidence of vitreoretinal complications after PK was 3.3% (52/1,594). The mean follow-up period was 38.5 ± 29.8 months. The mean time for vitreoretinal complications to occur was 4.8 months. The most common vitreoretinal complication was vitreous hemorrhage (0.75%), and others included choroidal detachment (0.7%), endophthalmitis (0.6%), and retinal detachment (0.5%). Majority of vitreous hemorrhage, endophthalmitis, and choroidal detachment occurred within 1 month postoperatively, but most cases of cystoid macular edema and epiretinal membrane occurred after 3 months. At follow-up after PK, the mean corrected distance visual acuity was worse among eyes that experienced vitreoretinal complications compared with eyes that did not (P = 0.013). Vitreoretinal complications after PK occurred in a significant percentage, resulting in persistent reduction of corrected distance visual acuity. Given this, it is of particular importance to control intraoperative and postoperative intraocular pressure, infection, and inflammation which will contribute to decrease in the incidence of vitreoretinal complications after PK.

Sub-Tenon Injections of Triamcinolone Acetonide Had Limited Effect on Cystoid Macular Edema Secondary to Nanoparticle Albumin-Bound-Paclitaxel (Abraxane).

Purpose. To report the first case of cystoid macular edema (CME) induced by nanoparticle albumin-bound- (nab-) paclitaxel treated with sub-Tenon injections of triamcinolone acetonide (STTA) with detailed long-term follow-up. Case. A 39-year-old Japanese woman with breast cancer presents with decreased vision in both eyes while receiving nab-paclitaxel. Two STTA treatments were administered for persistent CME in her right eye. Central retinal thickness (CRT) of the treated eye decreased after the first STTA, but there was no change after the second STTA. CRT of the other eye and bilateral visual acuity (VA) showed no change after each treatment. However, this patient experienced gradual recovery of visual function after nab-paclitaxel treatment was completed, 3 months after the second STTA. Improvements in VA and CRT did not overlap in time. Moreover, there was a big improvement time lag in VA between the eyes. Conclusion. Cessation of nab-paclitaxel could lead to resolution of CME more than STTA, although STTA had some effect. Since nab-paclitaxel has been recently approved for treating more types of malignancies, the number of the patients with this CME is expected to increase in the near future. Patients and physicians should understand this side effect and prepare for other treatment options.

Acetazolamide for Cystoid Macular Oedema in Bietti Crystalline Retinal Dystrophy

Bietti crystalline retinal dystrophy is a rare, inherited disorder whose hallmark is the presence of retinal crystal deposits associated with later chorioretinal degeneration. This condition may rarely be complicated by the development of cystoid macular oedema leading to rapid visual decline. Currently, treatment options for this complication of Bietti dystrophy are limited and the visual prognosis is poor. Here, we present a case of cystoid macular oedema associated with Bietti dystrophy that was successfully diagnosed using multimodal imaging techniques including optical coherence tomography and fluorescein angiography. These modalities confirmed the diagnosis of macular oedema and excluded other possible causes of oedema such as choroidal neovascularisation. In this patient, cystoid macular oedema was resolved with oral acetazolamide therapy, a treatment that has not been previously reported in this context. Acetazolamide treatment resulted in oedema resolution and improvement in visual function, and can be considered a therapeutic option for other patients with Bietti dystrophy who develop cystoid macular oedema.

Optical coherence tomography of fovea before and after laser treatment in retinopathy of prematurity.

Purpose:To study the fovea in preterm babies with Type I retinopathy of prematurity (ROP) before and after laser treatment using optical coherence tomography (OCT).Materials and Methods:This was a prospective observational case-control study including preterm neonates undergoing screening for ROP from May 2009 to July 2011. Group 1 included 30 eyes of 15 neonates with Type I ROP. A 532-nm laser was used for treatment in all cases for Group 1. Group 2 included 14 eyes of 7 preterm neonates without ROP that served as controls. OCT was performed under sedation in the lateral position before and after laser treatment. P <0.05 was considered statistically significant.Results:The mean initial central macular thickness (CMT) was comparable in both groups (P = 0.832) and statistically significantly correlated with gestational age (P = 0.015). No adverse effects on the anterior segment or posterior segment were observed. There was no significant difference in CMT before and after laser treatment in Group 1 (P = 0.007). There was one case of cystoid macular edema after laser treatment.Conclusion:The macula in preterm babies with Type 1 ROP was comparable to those without ROP. Gestational age was the only predictor of CMT.

Cistoid macular edema as first manifestation of sarcoidosis

The purpose of this study is to report a case of cystoid macular edema (CME) as a rare first manifestation of ocular sarcoidosis after cataract surgery. A 60-year-old male developed a CME following uneventful phacoemulsification cataract extraction on his left eye. It resolved with conventional medical therapy. One year later the patient was diagnosed with bilateral CME. Oral corticosteroid therapy produced a significant regression. His medical and ocular histories were unremarkable and all tests for etiological diagnosis were negative. There were inflammation recurrences in his left eye, which were also treated with steroids. Optical coherence tomography showed complete resolution of foveal thickening without improvement in vision. Four years later, the patient presented with CME in both eyes. The laboratory tests included high angiotensin-converting enzyme levels and a gallium scan which were also consistent with sarcoidosis. Azathioprine was needed for management of ocular involvement, but it was withheld due to side-effects. At the present time, the CME is controlled with low-dose corticoids. Ocular involvement in sarcoidosis occurs in 20-50 % of patients. CME is not often the initial manifestation of the disease, but ocular sarcoidosis may present with a wide variety of ocular symptoms in all parts of the eye. Therefore, sarcoidosis should be kept in mind when evaluating a patient with ocular inflammation.

Avaliação do edema macular após cirurgia não complicada de facoemulsificação com implante de lente intraocular por meio da tomografia de coerência óptica spectral domain

To evaluate macular edema after uncomplicated phacoemulsification with implantation of intraocular lens by spectral domain optical coherence tomography (OCT). Prospective study was conducted in 62 eyes of patients underwent phacoemulsification with implantation of intraocular lens. Patients were evaluated before surgery and after surgery at day 1, week 1, week 2 and week 4. Visual acuity (VA), anterior chamber cells and 200 x 200 macular cube optical coherence tomography were measured. After phacoemulsification there was an improvement in visual acuity, decreasing inflammation, and increased macular thickness and macular volume. There was one case of cystoid macular edema. There was a weak inverse correlation between visual acuity and central macular thickness, and between visual acuity and macular volume. We observed a week direct correlation between inflammation and macular volume. Subclinical macular edema develops even after uncomplicated cataract surgery in patients not predisposed. The spectral domain optical coherence tomography was able to detect small increases in macular thickness in the study period.

Subtenon triamcinolone injection for postoperative cystoid macular edema associated with tafluprost

PurposeWe report the successful treatment of a case of cystoid macular edema (CME) associated with topical tafluprost, which was accompanied by serous retinal detachment (SRD).CaseA 78-year-old woman underwent intraocular lens suture surgery, including anterior vitreous cutting, for crystalline lens dislocation in the right eye. Tafluprost was initiated 12 weeks after surgery. Intraocular pressure (IOP) was controlled at 10–14 mmHg. Visual acuity remained at 20/40–30/40. However, the patient complained of blurred vision (20/200) 9 months after surgery. CME accompanied by SRD was identified by optical coherence tomography (OCT) and treated with subtenon triamcinolone injection. Visual acuity rapidly increased to 20/50, and the volume of SRD decreased in a few days. Discontinuation of tafluprost and initiation of diclofenac eye drops improved visual acuity to 20/40 and resulted in improved OCT findings within a few weeks. Three months after injection, tafluprost was resumed along with diclofenac. No recurrence of CME occurred over the following 3 months, and IOP was controlled at 10–15 mmHg.ConclusionSRD is considered to be a symptom of treatment-resistant CME, which may lead to poor visual acuity after recovery. In such cases, subtenon triamcinolone injection should be strongly considered at an early stage.

Cystoid macular edema associated with acitretin

Cystoid macular edema represents a "final common pathway" response of the retina to a variety of insults. It has been reported in association with vascular problems, inflammatory conditions, inherited diseases, tractional problems, intraocular surgery and medications. We report a case of cystoid macular edema associated with acitretin in a 65-year-old woman and document its resolution with optical coherence tomography (OCT).