Alternative treatment methods in eyes with pseudophakic cystoid macular edema
Main Article Content
Abstract
Cystoid macular edema is a common cause for unexplained painless vision loss after cataract surgery. Even the pathogenesis of pseudophakic cystoid macular edema (PCME) still remains undefined, it can most frequently occur in eyes with high vasoactive profile, had complicated cataract surgery such as posterior capsule rupture and risk of inflammation. Increased inflammation, ultimately leading to the breakdown of the blood-retinal barrier and cystic accumulation of extracellular intraretinal fluid. The natural history of PCME is spontaneous resolution without any treatment in most of patient, but it may take weeks or months, in addition permanent visual morbidity may occur in some cases. Therefore there is lack of consensus regarding treatment approach for this common ocular condition.
In this review treatment alternatives of PCME and its relation with underlying patho-physiologic mechanism are evaluated.
Article Details
Copyright (c) 2019 Altintas AGK.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Yonekawa Y, Kim IK. Pseudophakic cystoid macular edema. Curr Opin Ophthalmol. 2012; 23: 26–32. Ref.: https://goo.gl/Cspwmg
Daien V, Papinaud L, Domerg C, Lacombe S, Daures JP, et al. Incidence and characteristics of cystoid macular edema after cataract surgery. Ophthalmology. 2016; 123: 663–664. Ref.: https://goo.gl/hDfbEb
Altıntaş AGK, Coban P, Arifoğlu HB, Koklu G, Ozcan PY, et al. Comparison of phaco parameters effect on macular thickness changes after uneventful phacosurgery in diabetic and non-diabetic patients. Int Eye Sci 2016; 16: 201-206. Ref.: https://goo.gl/16c9r4
Packer M, Lowe J, Fine H. Incidence of acute postoperative cystoid macular edema in clinical practice. J Cataract Refract Surg. 2012; 38: 2108–2111. Ref.: https://goo.gl/zPXwEN
Henderson BA, Kim JY, Ament CS, Ferrufino-Ponce ZK, Grabowska A, et al. Clinical pseudophakic cystoid macular edema. Risk factors for development and duration after treatment. J Cataract Refract Surg. 2007; 33: 1550–1558 . Ref.: https://goo.gl/vvTRp5
Zur D, Loewenstein A. Postsurgical cystoid macular edema. Dev Ophthalmol. 2010; 47: 148–159. Ref.: https://goo.gl/adVGCG
Lobo C. Pseudophakic cystoid macular edema. Ophthalmologica. 2012; 227: 61–67. Ref.: https://goo.gl/qz5tjn
Shields MK, Adler PA, Fuzzard DRW, Chalasani R, Teong JMY. A Case of Acute Bilateral Irvine-Gass Syndrome following Uncomplicated Phacoemulsification, Demonstrated with Optical Coherence Tomography. Case Rep Ophthalmol. 2015; 6: 143–148. Ref.: https://goo.gl/zaonTU
Kiernan DF, Hariprasad SM. Controversies in the Management of Irvine-Gass Syndrome Ophthalmic Surgery, Lasers and Imaging Retina 2013; 44: 522-527. Ref.: https://goo.gl/mtTx2X
Quintana NE, Allocco AR, Ponce JA, Magurno MG. Non steroidal anti-inflammatory drugs in the prevention of cystoid macular edema after uneventful cataract surgery. Clin Ophthalmol. 2014; 8: 1209–1212 . Ref.: https://goo.gl/4MnDaV
Sheppard JD. Topical bromfenac for prevention and treatment of cystoid macular edema following cataract surgery: a review. Clin Ophthalmol. 2016; 10: 2099–2111. Ref.: https://goo.gl/kr2PsP
Sahu S, Ram J, Bansal R, Pandav SS, Gupta A. Effect of topical ketorolac 0.4%, nepafenac 0.1%, and bromfenac 0.009% on postoperative inflammation using laser flare photometry in patients having phacoemulsification. J Cataract Refract Surg. 2015; 41: 2043–2048. Ref.: https://goo.gl/vxFdd1
Walters TR, Goldberg DF, Peace JH, Gow JA, Bromfenac Ophthalmic Solution 0.07% Once Daily Study Group Bromfenac ophthalmic solution 0.07% dosed once daily for cataract surgery: results of 2 randomized controlled trials. Ophthalmology. 2014; 121: 25–33. Ref.: https://goo.gl/huAoTz
Wittpenn JR1, Silverstein S, Heier J, Kenyon KR, Hunkeler JD, et al. A randomized, masked comparison of topical ketorolac 0.4% plus steroid vs steroid alone in low-risk cataract surgery patients. Am J Ophthalmol. 2008; 146: 554–560. Ref.: https://goo.gl/qZnny2
Dal D, Sarac O, Toklu Y, Kocak Altintas AG, Cakmak HB, et al. The Effect of Perioperative Topical Ketorolac 0.5% on Macular Thickness after Uneventful Phacoemulsification. J Ophthalmol. 2017 ;2017: 4271671 . Ref.: https://goo.gl/kjniWk
Warren KA Bahrani H Fox JE. NSAIDs in combination therapy for the treatment of chronic pseudophakic cystoid macular edema. Retina. 2010; 30: 260–266. Ref.: https://goo.gl/e3maK4
Sivaprasad S McCluskey P Lightman S. Intravitreal steroids in the management of macular oedema. Acta Ophthalmol Scand. 2006; 84: 722–733. Ref.: https://goo.gl/rxoe6u
Benhamou N1, Massin P, Haouchine B, Audren F, Tadayoni R, et al. Intravitreal triamcinolone for refractory pseudophakic macular edema. Am J Ophthalmol. 2003; 135: 246–249. Ref.: https://goo.gl/3JrZVo
Randazzo A, Vinciguerra P. Chronic macular edema medical treatment in Irvine-Gass syndrome: case report. Eur J Ophthalmol 2010; 20: 462-465. Ref.: https://goo.gl/UYzSZp
Herrero-Vanell R, Cardillo JA, Kuppermann BD. Clinical applications for the sustained-release dexamethasone implant for treatment of macular edema. Clin Ophthalmol. 2011; 5: 139–146. Ref.: https://goo.gl/9ddAoP
Williams GA1, Haller JA, Kuppermann BD, Blumenkranz MS, Weinberg DV, et al. Dexamethasone posterior-segment drug delivery system in the treatment of macular edema resulting from uveitis or Irvine-Gass syndrome. Am J Ophthalmol. 2009; 147: 1048–1054. Ref.: https://goo.gl/4DQjiJ
Mayer WJ, Kurz S, Wolf A, Kook D, Kreutzer T, et al. Dexamethasone implant as an effective treatment option for macular edema due to Irvine-Gasssyndrome. J Cataract Refract Surg. 2015; 41: 1954-1961. Ref.: https://goo.gl/xL8XH2
Landré C, Zourdani A, Gastaud P, Baillif S. Treatment of postoperative cystoid macular edema (Irvine-Gass syndrome) with dexamethasone 0.7 mg intravitreal implant. J Fr Ophtalmol 2016; 39: 5-11. Ref.: https://goo.gl/hHNxQS
Klamann A, Böttcher K, Ackermann P, Geerling G, Schargus M, et al. Intravitreal Dexamethasone Implant for the Treatment of Postoperative Macular Edema. Ophthalmologica. 2016; 236: 181-185. Ref.: https://goo.gl/UUVzBP
Bellocq D, Korobelnik JF, Burillon C, Voirin N, Dot C, et al. Effectiveness and safety of dexamethasone implants for post-surgical macular oedema including Irvine-Gass syndrome: the EPISODIC stud study. Br J Ophthalmol 2015; 99: 979-983. Ref.: https://goo.gl/WHfNTD
Altintas AGK, Ilhan C, Citirik M. The management of Irvine-Gass Syndrome in a patient using Inhaler steroid. Int J Clin Exp Ophthalmol. 2019; 2: 1-5. Ref.: https://goo.gl/sF1ViW
Dutra Medeiros M1, Navarro R, Garcia-Arumí J, Mateo C, Corcóstegui B. Dexamethasone Intravitreal Implant for Treatment of Patients With Recalcitrant Macular Edema Resulting From Irvine-Gass Syndrome Investigative Ophthalmology & Visual Science. 2013; 54: 3320-3324. Ref.: https://goo.gl/LRyo6G
Keilani C, Halalchi A, Wakpi Djeugue D, Regis A, Abada S. Evaluation of best corrected visual acuity and central macular thickness after intravitreal dexamethasone implant injections in patients with Irvine-Gass syndrome: A retrospective study of six cases. Therapie. 2016; 71: 457-465. Ref.: https://goo.gl/bbjHMD
Sudhalkar A, Chhablani J, Vasavada A, Bhojwani D, Vasavada V, et al. Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine-Gasssyndrome: a prospective case series. Eye (Lond). 2016; 30: 1549-1557. Ref.: https://goo.gl/4NDvZa
Fenicia V, Balestrieri M, Perdicchi A, Maurizi Enrici M, DelleFave M, et al. Intravitreal Injection of Dexamethasone Implant and Ranibizumab in Cystoid Macular Edema in the Course of Irvine-Gass Syndrome. Case Rep Ophthalmol. 2014; 5: 243–248. Ref.: https://goo.gl/ech1G1
Arevalo JF1, Maia M, Garcia-Amaris RA, Roca JA, Sanchez JG, et al. Intravitreal bevacizumab for refractory pseudophakic cystoid macular edema: the Pan-American Collaborative Retina Study Group results. Ophthalmology. 2009; 116: 1481–1487. Ref.: https://goo.gl/8ikaQq
Mason JO, Albert MA, Vail R. Intravitreal bevacizumab (Avastin) for refractory pseudophakic cystoid macular edema. Retina 2006; 26: 356-357. Ref.: https://goo.gl/nz1bsf
Mitropoulos PG, Chatziralli IP, Peponis VG, Drakos E, Parikakis EA. Intravitreal Ranibizumab for the Treatment of Irvine-Gass Syndrome. Ocul Immunol Inflamm. 2015; 23: 225-231. Ref.: https://goo.gl/d9mJfs
Demirel S, Batioğlu F, Özmert E. Intravitreal Ranibizumab for the Treatment of Cystoid Macular Edema in Irvine-Gass Syndrome. J Ocul Pharmacol Ther. 2012; 28: 636-639. https://goo.gl/fa4dtw
Mason JO, III, Albert MA, Jr, Vail R. Intravitreal bevacizumab (Avastin) for refractory pseudophakic cystoid macular edema. Retina. 2006; 26: 356–357. Ref.: https://goo.gl/HC71a3
Spitzer MS1, Ziemssen F, Yoeruek E, Petermeier K, Aisenbrey S, et al. Efficacy of intravitreal bevacizumab in treating postoperative pseudophakic cystoid macular edema. J Cataract Refract Surg 2008; 34: 70–75. Ref.: https://goo.gl/zLmA5N
Matet A, Daruich A, Behar-Cohen F. Irvine-Gass Macular Edema Responding to the Combination of Oral Mineralocorticoid-Receptor Antagonist With Dexamethasone Drops. Ophthalmic Surg Lasers Imaging Retina. 2017; 48: 936-942. Ref.: https://goo.gl/WmUvbE
Deuter CM1, Gelisken F, Stübiger N, Zierhut M, Doycheva D. Successful treatment of chronic pseudophakic macular edema (Irvine-Gass syndrome) with interferon alpha: a report of three cases. Ocul Immunol Inflamm. 2011; 19: 216–218. Ref.: https://goo.gl/QHBtyT
Scarpa G. Bilateral cystoid macular edema after cataract surgery resolved by vitrectomy. Eur J Ophthalmol. 2011; 21: 677–679. Ref.: https://goo.gl/4evXba