A Case of Acute Bilateral Irvine-Gass Syndrome following Uncomplicated Phacoemulsification, Demonstrated with Optical Coherence Tomography

Abstract

Purpose: To report a case of acute bilateral Irvine-Gass syndrome. Methods: This is an observational case report. Results: An 82-year-old man with no significant ocular history developed postsurgical pseudophakic cystoid macular edema (CME; Irvine-Gass syndrome) on consecutive phacoemulsification cataract surgeries. His initial first-eye (left) CME developed 25 days after surgery and was managed with topical preparations of dexamethasone 0.1% and ketorolac 0.4%, in addition to a routine post-cataract surgery drop regime. His left CME resolved completely on optical coherence tomography (OCT) by day 100, and he subsequently (after extensive discussion of CME risks) underwent cataract surgery on his right eye. He was commenced prophylactically on dexamethasone, ketorolac and oral indomethacin 25 mg t.d.s. immediately after surgery; however, he later developed CME (OD) on day 32 postoperatively. Within 6 months, he achieved complete resolution of his CME in both eyes. His clinical course was documented with serial OCT studies. Conclusion: Irvine-Gass syndrome remains an important differential diagnosis in the evaluation of blurred vision after cataract surgery, despite decreasing incidence. Those who experience CME following their first cataract operation should be counseled about the risks of developing the condition in the contralateral eye, despite prophylactic measures.

Nonsteroidal antiinflammatory drugs and treatment of cystoid macular edema

“…However, efficacy of NSAID use on long-term visual outcomes was unclear 5,13 . Shields et al reported significant reductions in the incidence of clinical PCME with prophylactic use of topical NSAIDs, ketorolac 0,4% or nepafenac 0,1%, adjunctive to topical steroids 14 .…”

Disease of the Year: Differential Diagnosis of Uveitic Macular Edema

“…CME following cataract surgery, also known as Irvine-Gass syndrome, is a well-known cause of poor vision following uneventful cataract surgery. [87][88][89] The incidence of clinical (symptomatic) pseudophakic cystoid macular edema (PCME) has been greatly reduced because of the advances in surgical techniques (approximately 0.1-2.3%) including phacoemulsification and small-incision cataract surgery. 87,90 A large Differential diagnosis of CME 7 retrospective study including 81,984 eyes revealed that the incidence of PCME in eyes without operative complications, diabetes, or risk factors was 1.17%.…”

“…Patient factors predisposing to PCME include PCME in the contralateral eye, African-American origin, and any risk factor that may disrupt the blood-retinal barrier such as diabetes mellitus, uveitis, retinal vein occlusion, retinal degeneration, macular degeneration, radiation retinopathy, epiretinal membranes, choroidal tumors, prostaglandin analog use, and aging. 87,91,92 Surgical factors include inflammation-inducing complications such as retained lens material, posterior capsule rupture, vitreous loss and vitreomacular traction, and excessive intraoperative manipulations such as mechanical pupil stretch or iris prolapse during surgery, the presence of an anterior chamber intraocular lens, filtering or other glaucoma operations, and intraocular surgeries. 87 Conventionally, PCME is classified as angiographic (seen on FA) or clinical (associated with decreased visual acuity) and acute (within 6 months) or chronic (more than 6 months).…”

“…87,91,92 Surgical factors include inflammation-inducing complications such as retained lens material, posterior capsule rupture, vitreous loss and vitreomacular traction, and excessive intraoperative manipulations such as mechanical pupil stretch or iris prolapse during surgery, the presence of an anterior chamber intraocular lens, filtering or other glaucoma operations, and intraocular surgeries. 87 Conventionally, PCME is classified as angiographic (seen on FA) or clinical (associated with decreased visual acuity) and acute (within 6 months) or chronic (more than 6 months). 93 However, OCT definitions for CME have been recently added and the incidence of PCME varies between 0.2% and 20% 94 depending on the definition used for diagnosis, which include clinical, angiographic, and tomographic.…”

Alternative treatment methods in eyes with pseudophakic cystoid macular edema

“…With these process, Müller cells become swollen and lysed than eventually developed cystic changes that result in varying degree of decrease in visual acuity. This detrimental effect on visual acuity may occasionally persist and lead to permanent vision loss [3,5,[7][8][9].…”