Optical Coherence Tomography Characteristics of Pseudophakic Cystoid Macular Edema Before and After Treatment

Abstract

Purpose : Pseudophakic cystoid macular edema (PCME) is central macular edema after cataract surgery. The effect of treatment on OCT features of PCME is not well defined. In this retrospective, observational clinical study, we studied the effect of treatment on various OCT characteristics and summarized the observed trends.

Methods : Retrospective series of post-cataract eyes that underwent treatment for PCME within 6 months of cataract extraction along with FastMAC thickness scans with Heidelberg SPECTRALIS® between Jan 2013 and August 2016. Exclusion criteria included prior ME, retinal surgery, uveitis, diabetes, and retinal vein occlusion. Treatment for PCME included topical steroids only, combination with NSAID, or subTenon steroid. The pre-treatment OCT of PCME was compared to post-treatment OCT images. The A-scans were analyzed for presence and location of intraretinal cysts, subretinal fluid (SRF), central foveal thickness (CFT), and central subfield thickness (CST). Medical records were reviewed for relevant clinical characteristics. The pattern of ME (cone vs doughnut shape), site of maximal retinal thickness in the macula, and change in pattern of ME with treatment were recorded. Cone-shape (CS) pattern is defined as maximal thickening at fovea which decreases with increasing distance from center; doughnut-shape (DS) is described as diffuse retinal thickening within 3000μm of center but with relatively lesser thickening in central subfield.

Results : A total of 8 eyes of 7 patients were included. Pre-treatment visual acuity in LogMAR was 0.51±0.27. Final visual acuity was 0.33±0.16. The mean CST and CFT at the time of diagnosis were 483±183μm and 469±214μm, respectively. 3 of the 8 eyes had cysts under the foveal pit with SRF and had a CS pattern. 5 eyes had parafoveal cysts with minimal SRF; 3 of these had a DS pattern, 2 had focal thickening. All eyes with DS pattern had been started on ketorolac on postoperative day 1. 71% of eyes responded to treatment within 3 months. The greatest decrease in thickness was seen at the fovea irrespective of the shape (i.e. foveal SRF or cysts closest to fovea resolved first).

Conclusions : Most thickness scans of PCME had either a CS or DS pattern. All eyes with DS pattern were on ketorolac since surgery. Also, foveal edema was the first OCT characteristic to resolve with treatment. Further studies are needed to elucidate these relationships.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

CS

 

DS