Treatment for Cystoid Macular Edema

Treatment/Prognosis of Cystoid Macular Edema

The prognosis for untreated CME after cataract surgery (Irvine-Gass syndrome) is very good.  About half of the cases will regain normal vision in about 6 months.  A smaller percentage (up to 20%) will persist for up to 5 years.  Any medications that could cause CME should be discontinued immediately and a comprehensive eye exam should be done to ensure there are no other causative factors.  Many studies indicate treatment with prostaglandin inhibitors such as topical indomethacin 1% four times a day for one to four months.  This treatment coupled with topical steroids four times a day for three weeks and then tapered may be very effective. For prevention of CME, most cataract surgeons will pretreat patients with a topical non-steroidal anti-inflammatory (NSAID) medication a few days before surgery and for a few weeks after surgery.  Topical NSAIDs are also effective when CME occurs 6 weeks or more post-operatively.  Systemic NSAIDs and oral indomethacin may also be given.

If the CME is a result of RPE leakage due to conditions such as Retinitis Pigmentosa or chronic inflammation, then oral carbonic inhibitors have been shown to be most effective.

If CME is the primary condition with no known cause then several treatments may be attempted such as prostaglandin inhibitors, oral corticosteriods, steroid injections and topical steroids.  Intravenous methylprednisolone 1000mg daily for three days may be attempted for recurrent cases.  A vitrectomy (removing the vitreous) may be successful in cases of vitreomacular traction and even in certain cases that are unresponsive to other treatments though no vitreous disturbance is present. 

The patient should be seen regularly for follow-ups until the CME is completely resolved.