Prophylaxis and treatment of cystoid macular edema after cataract surgery

Abstract

O edema macular cistoide é uma das principais causas de baixa de visão após cirurgia de catarata. O processo inflamatório parece ser o principal fator causal do edema. São considerados fatores de risco complicações cirúrgicas, doenças retinianas prévias, diabetes, uveítes e uso de colírios de prostaglandinas. O diagnóstico é feito clinicamente, mas a angiografia fluoresceínica e a tomografia de coerência óptica também são ferramentas importantes para detectar o edema e auxiliar no diagnóstico diferencial. Apesar da profilaxia préoperatória não ter evidência científica, ela é preconizada especialmente nos casos com fatores de risco. O tratamento inicial é realizado com associação de corticoide e anti-inflamatório não hormonais tópicos. Os casos crônicos e refratários têm diversas alternativas de tratamento, sendo o uso de triancinolona e antiangiogênicos intravítreos as mais utilizadas. Este artigo se propõe a discutir diversos aspectos do edema macular cistoide pseudofácico. Descritores: Edema macular; Facoemulsificação; Anti-inflamatórios, não esteroides; Esteroides; Fatores de crescimento do endotélio vascular The authors declare no conflict of interest.

A manually made needle for treating Pseudophakic cystoid macular edema by injecting triamcinolone acetonide in the suprachoroidal space: A case report

“…The management of pseudophakic cystoid macular edema (PCME) usually done by topical application of NSAIDs and steroids before and after surgery, and subconjunctival triamcinolone can be considered in diabetic patients, 5 in case of treatment failure, then switching to posterior subtenon or intravitreal steroids are recommended. 6 However, when the vitreomacular traction is the leading force for cystic macular edema formation, then pars plana vitrectomy is recommended if the spontaneous release does not happen within months, especially in cases of moderate visual loss.…”

Comparison of macular thickness by optical coherence tomography measurements after uneventful phacoemulsification using ketorolac tromethamine, nepafenac, vs a control group, preoperatively and postoperatively

“…A smaller increase in macular thickness and less loss of contrast sensitivity might exist, thereby justifying the use of NSAIDs for high-risk patients. 20 However, a recent study concluded that the risk of CME in patients who underwent cataract surgery was low and that the reduction with the use of anti-inflammatory drugs was modest. 21 …”

Treatment of cystoid macular edema in a patient with primary open angle glaucoma and diabetic retinopathy by withdrawal of travoprost

“…Despite advances in cataract surgery, such as microincision and new phacoemulsification techniques, CME may occur even in uncomplicated surgeries. 1 The incidence of acute, visually significant CME has been reported from 1% to 2% of patients following uncomplicated phacoemulsification. 2,3 In diabetic patients, macular edema is the main cause for low visual acuity.…”