A 70-year-old man presents with deterioration of vision 3 weeks after cataract extractionand IOL implantation. Slit lamp examination shows honeycomb maculopathy and Fluorescinangiography {FA} shows 'flower petal' hyperfluorescence. The most likely diagnosis is -
CYSTOID MACULAR EDEMA (CME) It refers to collection of fluid in the outer plexiform(Henle's layer) and inner nuclear layer of the retina,centred around the foveola. Etiology It is associated with a number of disorders. A fewcommon causes are as follows: 1. As postoperative complication following cataract extraction and penetrating keratoplasty. 2. Retinal vascular disorders e.g., diabetic retinopathy and central retinal vein occlusion. 3. Intraocular inflammations e.g., pars planitis, posterior uveitis, Behcet disease. 4. As a side-effect of drugs e.g., following use of adrenaline eyedrops, especially for aphakic glaucoma. 5. Retinal dystrophies e.g., retinitis pigmentosa. Pathogenesis CME develops due to leakage of fluid following breakdown of inner blood-retinal barrier (i.e., leakage from the retinal capillaries). Clinical features 1. Visual loss. Initially there is minimal to moderate loss of vision, unassociated with other symptoms. If oedema persists, there may occur permanent decrease in vision. 2. Ophthalmoscopy in clinically established cases reveals a typical 'Honey-comb appearance' ofbmacula (due to multiple cystoid oval spaces) CME is best examined with a fundus contact lens on slit-lamp or +90D lens. 3. Fundus fluorescein angiography demonstrates leakage and accumulation of dye in the macular region which in a well-established case presents a 'flower petal appearance. Ref comprehensive ophthalmology AK Khurana 4/E pageno 243.
Age related macular degeneration
Central serous Retinopathy
Macular Dystrophy
Cystoid Macular Edema
Vitreous and retina