A 70-year-old man presents with deterioration of vision 3 weeks after cataract extraction and IOL implantation. Slit lamp examination shows honeycomb maculopathy and Fluorescin angiography (FA) shows 'flower petal' hyperfluorescence. The most likely diagnosis is:
D i.e. Cystoid Macular Edema - Delayed onset unexpected visual loss, typically with onset in 3-4 weeks postoperatively, presenting as decreased central visual acuity with yellow spot in fovea, honey comb appearance on slit lamp examination, and flower petal or petaloid pattern hyper fluorescence on FA after cataract surgery is characteristic of cystoids maculr oedema (CMO). FA in central serous chorioretinopathy gives smoke stack and ink blot appearance. Cystoid Macular Edema (CME) Definition and Etiology - CME is a final common pathological response of retina to a variety of insults, consisting of fluid accumulation in outer plexiform (Henle's) layer and inner nuclear layer of the central macula that results in the formation of visible cystic space. - Initially fluid accumulates intracellularly in Muller cells, with subsequent rupture forming microcystic spaces. These coalesce into larger cavities and may progress to lamellar hole formation at the fovea with irreversible impairment of central vision. - CME is commonly a/w intraocular inflammations (eg pars planitis), vascular incompetence (diabetes & RVO), vitreoretinal traction, inherited diseases (eg RP or dominant CME), medications (epinephrine, latanoprost) and most commonly following cataract surgeryQ (k/a Irvine-Gass syndrome). Agiographically evident CME is seen in 60% ECCE, 20% ICCE and 10-20% phacoemulsification cases (all uncomplicated). Clinically significant CME with decreased visual acuity, however, is seen only in 0.2-3% patients. - Planned posterior capsulorrhexis during phacoemulsification does not 1/t an increase prevalence of CME, whereas those with inadveent rupture of posterior capsule &/or persistent vitreous traction to anterior segment are at highest risk. Diabetic retinopathy also increases incidence of post cataract CME. - Conditions a/w CME include Postoperative Vascular Inflammatory - Cataract surgery - Diabetic retinopathyQ - Eale's disease (ECCE > ICCE > - Retinal vein - Behcet's Phacoemulsification)Q obstruction (RVO)Q syndrome - Inadveent posterior - Ocular ischemic - Birdshot capsular rupture syndrome choroidopathy - Penetrating - Coat's disease - Pars planitis keratoplasty - Choroidal - Scleritis - Astigmatic corneal neovascularization - Idiopathic incisions - Idiopathic juxta foveal vitritis - Scleral buckling (for telangiectasia - CMV retinitis RD) - Acute hypeensive - Toxoplamosis - Laser iridotomy retinopathy - Sarcoidosis - Cryotherapy for - Radiation retinopathy retinal breaks - Retinal aerial Fundal Tumors - Pan-retinal photo macroaneurysm - Choroidal coagulation Inherited melanoma - Nd YAG laser - Retinitis pigmentosaQ - Choroidal capsulotomy (risk - Gyrate atrophy hemangioma reduced if delayed for _ Autosomal dominant - Retinal capillary 6 months after CME hemangioma cataract surgery) Topical Medications Tractional (in aphakic) - Vitreo macular - Prostaglandin tractional syndromeQ (latanoprost) - Idiopathic epiretinal - Adrenaline membrane (epinephrine) - Nicotinic acid Clinical Presentation - There is typically pre-existing cause such as cataract surgery (most common) or diabetic retinopathy etc. - Blurring and distoion : The major symptom is decreased central visual acuity. Accompanying symptoms include metamorphopsia, micropsia, scotoma, ocular irritation, photophobia and conjunctival injection.
Age related macular degeneration (ARMD)
Central serous Retinopathy (CSR)
Macular Dystrophy
Cystoid Macular Edema