Article title:
Transient Macular Edema after Uncomplicated Cataract Surgery: Below the Surface
Authors:
Juldyz Beisekeeva, Alexandr Samoylenko, Sergei Kochergin
For citation:
Beisekeeva J., Samoylenko A., Kochergin S.Transient macular edema after uncomplicated cataract surgery: below the surface. Otorhinolaryngology, Head and Neck Pathology (ORLHNP). 2023; 2 (4): 37-47.
Abstract:
Purpose: To present analysis of 17 case reports of 17 patients who had an acute transient macular edema appeared after uneventful cataract surgery.
Observations: In literature about 12 case series of toxic macular edema development after cataract surgery are described and all of them were accompanied by the cefuroxime intracameral usage. Also, there are reports of macular edema development after several weeks after uncomplicated phacoemulsification due to pseudophakic cystoid macular edema (Irvine-Gass syndrome) or due to vitreomacular traction syndrome. We observed a series of transient acute macular edema with 3,8% incidence occurring on the first days after uncomplicated phacoemulsification with IOL implantation that had no signs of vitreomacular traction or acute inflammation. Optical coherence tomography (OCT) was performed on patients complaining on blur vision and who had signs of macular edema by ophthalmoscopy. By OCT high and often extensive neuroepithelium and local pigment epithelium detachments were observed on the first day after surgery in 17 patients with quiet postoperative condition of the eye. The edema resolved on the 3-6-th day by standard phaco accompanying pharmacological treatment. In most cases posterior vitreous cortex was adjacent to the retina except 3 patients with posterior vitreous detachment in macular area. We found a paper by Costen M.T.J. et al. (2007) about the same striking appearance of maculopathy called by authors “A-sign” maculopathy because of A-shaped pattern on OCT images in 3 patients after routine cataract surgery. Yaman A (2008) and Panagiotidis D (2010) also reported same findings after uncomplicated cataract surgery. We compared our findings with 3 papers mentioned above, as well as with typical pseudophakic cystoid macular edema (CME) and vitreomacular traction syndrome.
Conclusion: It’s obvious that observed case series are cefuroxime induced. But its comparison with CME in terms of morphology of the macula could improve our understanding of mechanisms of the interstitial fluid flow in the eye tissues.
Keywords:
macula; pseudophakic cystoid macular edema; phacoemulsification; Irvine-Gass syndrome.