Vitreous & Retina





















Macular Diseases
Cystoid macular edema in a case of chronic macular pucker.

  • One of the most common cause of vision loss following uncomplicated cataract removal either with or without implantation of intraocular lens
  • Other conditions that may be complicated with CME include: diabetes, intraocular inflammation, vascular occlusions, epiretinal membrane, macroaneurysm, exudative age-related macular degeneration, hypotony and retinal detachment
  • Clinical features:
    • Symptoms:
      • Reduced visual acuity
      • Hyperopic shift refraction
    • Signs:
      • Loss of foveal depression
      • Thickening of the retina associated with translucent intraretinal cystoid spaces at the posterior pole
  • Fluorescein angiography demonstrates:
    • Dye leakage from small points in the midsection of each capillaries
    • Pooling of fluorescein in obliquely oriented henle layer which gives rise a characteristic petaloid staining patter in the perifoveal region
    • Late staining of the optic nerve is associated with inflammatory CME, typically after cataract extraction
  • Optical coherence tomography (OCT) is very helpful for diagnosis as well as for follow-up of treatment
  • Management:
    • Rule out infectious process, intraocular derangement such as entrapment of the iris or vitreous prolapse in the wound, uveitis or diabetic retinopathy
    • Therapeutic approach with topical corticosteroid or cyclo-oxygenase inhibitor
    • Sub-tenon's or intravitreal corticosteroid injection in refractory cases
    • Nd:YAG laser vitreolysis
    • Vitrectomy in selected cases
    • Intraocular lens removal or replacement

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