Cystoid Macular Edema In Eyes Research Articles

Fluid aspiration from intraretinal cysts for refractory diabetic macular edema

PURPOSE: To report the surgical outcome of fluid aspiration in intraretinal cysts as a novel treatment approach for the refractory cystoid macular edema (CME) associated with diabetic retinopathy. METHODS: This retrospective consecutive case series examined eight patients with refractory CME who underwent intraretinal cyst fluid aspiration using a 38-gauge subretinal infusion needle during pars plana vitrectomy. We reviewed changes in central retinal thickness (CRT), best-corrected visual acuity (BCVA), and central sensitivity among patients followed up for 12 months post-surgery. RESULTS: CRT on optical coherence tomography (μm) significantly improved at 12 months post-surgery (308 ± 99) compared to before surgery (480 ± 141) (P < 0.005). During the follow-up period, CME relapsed in one eye. The BCVA (logarithm of the minimal angle of resolution) at 12 months post-surgery (0.23 ± 0.32, Snellen equivalent: 20/50) was significantly better than the preoperative BCVA (0.39 ± 0.29, Snellen equivalent: 20/63) (P < 0.01). The mean deviation value of central sensitivity did not significantly change between preoperative (-2.5 ± 2.1) and postoperative (-2.2 ± 2.2) assessments (P = 0.07). CONCLUSIONS: Fluid aspiration in intraretinal cysts may be a treatment option for refractory CME in eyes with diabetes.

Fluocinolone acetonide implant scleral fixation for cystoid macular edema in eyes with iris–lens diaphragm disruption

Abstract This is a two-center, case series of three patients with postoperative refractory cystoid macular edema (CME) and disruption of the iris–lens diaphragm, submitted to scleral fixation of fluocinolone acetonide implant. All patients achieved successful CME reduction with visual acuity improvement. The surgical procedure was uneventful in all cases; however, one patient developed hypotony with leakage from the scleral tunnel, which was successfully resolved with reinforcement of the suture and injection of viscoelastics in the anterior chamber. No case of implant migration was observed and patients did not report any visual field disturbances. Our results emphasize this surgical technique as an effective and safe procedure for patients with persistent CME and disruption of the iris–lens diaphragm.

Schisis-like Cystoid Macular Edema in Eyes with Diffuse Laser-treated Scars

Schisis-like Cystoid Macular Edema in Eyes with Diffuse Laser-treated Scars

Case Report: Branch Retinal Vein Occlusion Post mRNA SARS-CoV-2 (COVID-19) Vaccination.

Systemic thromboembolic complications are well documented to be associated with Coronavirus disease 2019 (COVID-19), however, there has been a growing number of reports regarding ocular complications stemming from COVID-19 vaccinations. This case illustrates a clear temporal and possible causal relationship of COVID-19 vaccination with an ocular microvascular disorder, namely retinal vein occlusion. To report a case of inferotemporal branch retinal vein occlusion after mRNA SARS-CoV-2 vaccination. A middle-aged female developed right eye central scotoma two days after COVID-19 vaccination. She had transient hypertension during the first two days post-vaccination. A decrease in visual acuity (6/18) was documented. Initial retinal findings included flame-shaped hemorrhages and cotton wool spots along inferotemporal branch retinal vessels. Optical coherence tomography revealed right eye cystoid macular edema. Laboratory investigation revealed mildly raised erythrocyte sedimentation rate and C-reactive protein. Other systemic examinations were unremarkable. She was treated for right eye inferotemporal branch retinal vein occlusion with cystoid macular edema and was given intravitreal anti-vascular endothelial growth factor monthly in three doses. Her visual acuity improved to 6/6 with resolved cystoid macular edema. This case illustrates a clear temporal and possible causal relationship between COVID-19 vaccination and retinal vein occlusion. Post vaccination transient hypertension, or the immunological and inflammatory response to the vaccine may have contributed to the venous occlusive event in this case. Eye care providers should remain aware of this possibility. The effectiveness of intravitreal anti-vascular endothelial growth for the treatment of macular edema secondary to branch retinal vein occlusion was demonstrated in this patient.

Clinical Outcome of Cystoid Macular Edema in Silicone Oil-Filled Eyes.

Purpose: To investigate the clinical outcome of cystoid macular edema (CME) in eyes undergoing silicone oil (SO) tamponade with subsequent SO removal (SOR). Methods: A retrospective case series of adult patients with CME treated with SO tamponade and SOR was conducted between January 2015 and January 2021. Exclusion criteria included eyes with a prior SO tamponade, those that did not undergo SOR, or those with infectious/inflammatory diagnoses. The primary outcomes were the incidence and resolution rates of CME in eyes with SO tamponade that had undergone SOR. The secondary outcomes included changes in best-corrected visual acuity (BCVA) and central field thickness (CFT). Results: Nineteen eyes of 19 patients (58% men) aged 52 years (interquartile range [IQR], 45-66 years) met the study inclusion criteria. The median (IQR) follow-up duration post SOR was 22 (8-35) months. The mean CFT decline for the CME-resolved cases was 13.1 µm/mo (P = .257). CME resolved in only 10 eyes (53%), 7 (67%) of which occurred after SOR. The median (IQR) BCVA was 20/400 (20/200 to 20/1262) at CME diagnosis and 20/796 (20/252 to hand motions) after SOR, with 0.184 worsening in logMAR BCVA (P = .340). Medical treatment was not associated with CME resolution compared with observation (50% vs 89%, respectively; P = .069). Eyes with proliferative vitreoretinopathy (PVR) had a higher rate of persistent CME compared with eyes with other diagnoses (78% vs 10%, respectively; P = .005). Conclusions: Nearly half had nonresolution of CME after SO was removed. The VA at the last follow-up was unaffected by CME resolution. Preoperative PVR may be a risk factor for unresolved CME.

Incidence of pseudophakic cystoid macular edema in eyes with and without pupil expansion device.

Novel pupil expansion devices are widely recognized for their intraoperative feasibility in safe small pupil cataract surgeries. To assess whether the use of pupil expansion devices affects recovery from cataract surgery. A post hoc analysis of five consecutive prospective randomized clinical trials. 536 eyes of 536 patients undergoing routine cataract surgery were analysed according to the use of pupil expansion device. Thirty-four eyes were operated with pupil expansion device and 502 eyes without. Clinical outcome parameters were recorded at 28days and 3months. Patient age and gender distribution, and baseline clinical outcome parameters were comparable between study groups. Pseudoexfoliation syndrome, glaucoma and medication for benign prostatic hyperplasia were more frequently present; phacoemulsification energy was higher and operation time longer in eyes with pupil expansion device. At 28days, aqueous flare increased by 12.0±25.1pu/mseconds and mean central subfield macular thickness by 16.2±24.4μm in eyes with pupil expansion device, when compared to 4.6±14.8pu/mseconds (p=0.015) and 7.0±33.9μm (p=0.064) in eyes without the device. At 3-month follow-up, clinically significant pseudophakic cystoid macular edema (PCME) was reported in 12% of eyes with pupil expansion device and in 2% of eyes without (p=0.006). After adjusting for the presence of confounding factors, hazard for clinically significant PCME was greater in eyes with pupil expansion device than in those without (HR 5.41, 95% CI 1.35-21.71, p=0.017). The use of pupil expansion device may predispose eyes to increased risk of clinically significant PCME. Effective anti-inflammatory treatment and follow-up are warranted in eyes with pupil expansion device.

Intravitreal Aflibercept as Rescue Therapy for Post-Radiation Cystoid Macular Edema Resistant to Intravitreal Bevacizumab: Outcomes at 1 Year

Background/Aims: To investigate the efficacy of intravitreal aflibercept as rescue therapy for post-radiation cystoid macular edema (CME) resistant to prior treatment with intravitreal bevacizumab (IVB). Methods: Retrospective, interventional, case-controlled series. Eyes with persistent post-radiation CME were treated with intravitreal aflibercept (2 mg/0.05 mL). Central macular thickness (CMT) and visual acuity were compared to a matched control group treated with only IVB at 1 year. Results: Ten eyes of 10 patients were included, with 5 eyes in the intervention and 5 in the control group. The eyes in the intervention group had previously been treated with IVB (mean 11.6 injections, range 6-22) but failed to show resolution of CME. Following rescue treatment with a mean of 9 injections of aflibercept, the mean CMT was reduced from 463 ± 138 to 267 ± 80 μm (p = 0.02) and the mean Snellen visual acuity was improved from 20/67 to 20/42 (p = 0.03). At 1 year, the eyes in the intervention group had lower CMT (267 ± 80 vs. 361 ± 71 μm, p = 0.09) and significantly better Snellen visual acuity (20/48 vs. 20/76, p = 0.02) compared to the control group. Conclusions: Aflibercept may be an effective rescue therapy for persistent post-radiation CME in eyes with incomplete response to IVB, with reduction in CMT and improvement in visual acuity.

Non Leaking Cystoid Macular Edema

The current study was conducted to report the discrepancy in findings between Spectral Domain-Optical Coherence Tomography (SD-OCT) & Fundus Fluorescein Angiography (FFA) examinations of the macular area regarding Cystoid Macular Edema (CME) in patients with diabetic retinopathy (DR) or retinal vein occlusion (RVO). Patients M This was a retrospective observational case study, involved 205 eyes of 179 patients. Eyes with diabetic retinopathy or retinal vein occlusion those underwent SD-OCT & FFAwere included in the study. All eyes had SD-OCT detected CME. Results; In the current study, SD-OCT detected CME was associated with diabetic retinopathy in 56.1% of eyes & with retinal vein occlusion in 43.9 % of eyes. CME associated with DR or RVO was undetected on FFA examination in 12.2% and 7.3 % of eyes, respectively. Conclusion; Both SD-OCT & FFA were complementary to each other in the detection of CME in eyes with DR or RVO. The use of both SD-OCT & FFA aided in the diagnosis, the choice of the treatment option &the final visual outcome.

CYSTOID MACULAR EDEMA WITHOUT MACULAR THICKENING

This is a retrospective observational case series of 37 eyes of 32 patients meeting the inclusion criteria intended to describe the appearance, prevalence, and associated risk factors for cystoid macular edema in eyes with normal foveal thickness and contour as determined by optical coherence tomography (OCT). A retrospective review of all patients with macular disease who underwent OCT evaluation at the New England Eye Center from January to March 2007 and met the study inclusion criteria was performed. Optical coherence tomography scans were evaluated for the presence of intraretinal cystic fluid or cystoid macular edema but with normal retinal thickness and foveal contour. Retinal thickness and contour were evaluated using OCT mapping software. The main outcome measures were as follows: OCT-defined entity based on the presence of cystoid spaces within the fovea, "normal" foveal thickness (<252 microm), normal foveal contour, and best-corrected visual acuity on the date of examination. Thirty-seven eyes of 32 patients were determined to have cystoid macular edema with normal foveal thickness and contour on OCT. The overall prevalence within our patient population was 4.9%. Mean foveal thickness (standard deviation) for these patients was 201.4 microm (28.9) compared with normal mean foveal thickness (standard deviation) of 212 microm (20.0). Of the 32 patients, 17 (53.1%) had a primary diagnosis of age-related macular degeneration. The mean visual acuity (Snellen; logarithm of the minimum angle of resolution) was 20/80 (0.60). Cystoid macular edema in the setting of normal foveal thickness and contour as determined by OCT has not been extensively described. This entity is not pathognomonic of a single diagnosis and can occur in the setting of several disparate diagnoses as seen in our cohort. Chief among these were age-related macular degeneration and diabetic retinopathy. Acute postcataract cystoid macular edema was absent.

EFFECT OF ORAL PENTOXIFYLLINE ON CYSTOID MACULAR EDEMA ASSOCIATED WITH CENTRAL RETINAL VEIN OCCLUSION

To determine whether oral pentoxifylline, a xanthine-derived hemorheologic agent, decreases cystoid macular edema (CME) and improves visual acuity in eyes with a perfused central retinal vein occlusion (CRVO). Retrospective chart review of consecutive patients on pentoxifylline (400 mg po TID) for CRVO was performed. Inclusion criteria included CME, pentoxifylline use for at least 1 month, and a follow-up period of at least 4 months. Exclusion criteria included nonperfused or indeterminate CRVO, the presence of neovascularization, and previous or concurrent laser therapy or any other treatment for CRVO. Statistical analysis of collected data was performed. Eleven patients were identified. All patients had a perfused CRVO. The mean best-corrected Early Treatment Diabetic Retinopathy Study visual acuity was 60 letters (Snellen equivalent 20/128) before the initiation of oral pentoxifylline. The mean time from onset of CRVO to start of pentoxifylline therapy was 5 months (range, 1-12 months). The mean duration of pentoxifylline use was 5.3 months (range, 2.5-10.2 months). The mean follow-up period was 8 months (range, 2.7-16.5 months). Cystoid macular edema had improved in 64% (7/11) of eyes at last follow-up as measured by biomicroscopy and optical coherence tomography. The visual acuity was not significantly changed at 62 letters (20/128 +2) (Student t-test, P = 0.7) at last follow-up. There were no significant side effects from pentoxifylline. One patient had mild gastrointestinal disturbance. Pentoxifylline has a favorable adverse effect profile, and can reduce CME in eyes with CRVO. Visual acuity does not appear to change significantly. A larger, randomized, multiarmed clinical trial evaluating the effects of pentoxifylline as an adjunctive treatment modality may be of benefit since even a small positive effect in altering the natural history of CME related to CRVO may be of value for these patients.

Optical coherence tomography of cystoid macular edema associated with retinitis pigmentosa

PURPOSE: To detect cystoid macular edema in consecutive eyes with retinitis pigmentosa by means of optical coherence tomography and to study the correlation between cross-sectional structures and angiographic findings in cystoid macular edema. METHODS: In a prospective study, cross-sectional images through the fovea were evaluated by means of optical coherence tomography in 89 phakic eyes of 46 patients with retinitis pigmentosa. Eyes showing cystoid appearance in the macula in the optical coherence tomographic images were further studied with measurement of the dimensions of cystoid lesions and with a fluorescein angiogram either at 18 minutes after dye injection or later. RESULTS: Cystoid lesions were observed in the macula in optical coherence tomographic images in 12 eyes in six (13%) of 46 patients. In these eyes, the width of total area of the cystoid lesions was positively correlated with the grade of fluorescein angiogram (Spearman rank correlation coefficient, r = .629; P = .029), but the thickness of the neurosensory retina at the center of the fovea was not. Among three variables for grading cystoid macular edema, consisting of angiographic grade, thickness of the neurosensory retina at the center of the fovea, and width of total area of the cystoid lesions, only the last measure was significantly correlated with best-corrected visual acuity (Pearson correlation coefficient, r = .693; P = .012). CONCLUSION: Cystoid macular edema in eyes with retinitis pigmentosa could easily be detected with the use of optical coherence tomography independent of the angiographic degree of dye leakage. The size of cystoid lesions demonstrated in the optical coherence tomographic images, especially the thickness of the neurosensory retina at the center of the fovea, was not necessarily correlated with the angiographic grading of dye leakage. Measurement of the width of total area of the cystoid lesions in the optical coherence tomographic images is significantly correlated with the loss of visual acuity.

Fluorescein angiographic evaluation of the effect of latanoprost treatment on blood-retinal barrier integrity: A review of studies conducted on pseudophakic glaucoma patients and on phakic and aphakic monkeys

Endogenous prostaglandins (PGs) have been claimed to play a role in the development of cystoid macular edema (CME). Two fluorescein angiographic studies evaluating the effect of latanoprost, a new ocular hypotensive PG analogue, on blood-retinal barrier integrity are, therefore, reviewed here. In the first study, six of eight unilaterally aphakic cynomolgus monkeys were treated bilaterally once daily for six months with 0.035% latanoprost (seven times the clinically used oculohypotensive concentration). Two of the animals served as controls. Fluorescein angiography of the fundus after one, three and six months of treatment revealed no leakage of fluorescein in any of the 16 eyes. In another study, pseudophakic eyes of 16 glaucoma patients who received twice-daily treatment with 0.006% latanoprost for four weeks were compared to eight patients treated with placebo. Biomicroscopic examination did not reveal any signs of CME and only one placebo-treated eye revealed a slight perifoveal leakage of fluorescein. These studies suggest that topically-applied latanoprost does not have a fluorescein angiographically detectable direct effect on the integrity of the blood-retinal barrier system in phakic or aphakic monkey eyes or in pseudophakic human eyes. This does not rule out the occurrence of CME in eyes more susceptible to CME, due to vitreous loss, posterior capsulotomy, or other postoperative situations. Especially in those eyes a study with latanoprost is proposed. Since, fluorescein angiography is a rather crude method of detecting abnormalities of the blood-retinal barriers, vitreous fluorometry in addition is suggested.

Cystoid Macular Edema Following Penetrating Keratoplasty: Incidence and Prognosis

The incidence of clinically significant and angiographically documented cystoid macular edema (CME) following penetrating keratoplasty was studied in a consecutive series of 102 eyes over an average follow-up of 30 months. CME was seen only in the aphakic eyes. Twenty out of 68 eyes in this group developed CME. There was a statistically significant higher incidence of CME in eyes undergoing vitrectomy than in eyes not undergoing vitrectomy (p less than .01). Also, there was a higher incidence of CME in eyes with aphakic bullous keratopathy (p less than .01) and pseudophakic bullous keratopathy (p less than .05), when compared to eyes undergoing combined cataract extraction and corneal transplantation. All eyes with CME were empirically treated with oral prednisone (two eyes) or oral ibuprofen (18 eyes). Over an average follow-up of nine months, 13 of these eyes showed complete resolution of their CME with improvement in visual acuity to 20/60 or better in 12 eyes.

The national, prospective, randomized vitrectomy study for chronic aphakic cystoid macular edema. Progress report and comparison between the control and nonrandomized groups

Three years ago, a prospective, randomized, collaborative study investigating the effectiveness of vitrectomy for chronic aphakic cystoid macular edema in eyes with vitreous adherent to the cataract wound but without an intraocular lens was started. To date, the study consists of 130 eyes which have been assigned to three different groups. Without disturbing the data related to the question of the effectiveness of surgery, an analysis of patient histories and eye findings reveal interesting facts. The time between cataract surgery and onset of visual decrease was three months. Most of the eyes have a detached posterior vitreous face, and only 4% had evidence of vitreous traction on the macula. All eyes demonstrated some degree of flare and cells in the aqueous or vitreous, and the presence of systemic vascular disease in the patient does not seem to determine the eye's long term visual performance.