Pseudophakic (Irvine-Gass) Macular Edema Clinical Presentation

  • Author: David G Telander, MD, PhD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 21, 2010
 

History

Patients with cystoid macular edema (CME) usually present with decreased or blurry vision.

Patients presenting with CME often have a history of cataract surgery, diabetes, retinal vein occlusion, or uveitis.

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Physical

Slit lamp biomicroscopy reveals blunted or irregular foveal light reflex, retinal thickening, and/or intraretinal cysts in the foveal region.

Additional examinations can help elicit the cause for CME.

For uveitis, evidence of intraocular inflammation manifested by anterior chamber cells and flare and vitreous cells may be present in some cases.

For epiretinal membrane/macular pucker, dilated fundus examination can help reveal the membrane on the retinal surface.

Retinal examination can reveal diabetic retinopathy associated with the diabetic retinal edema.

Optic disc edema is also classically present in Irvine-Gass syndrome.

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Causes

The following risk factors resulting from previous ocular surgical procedures, systemic diseases, drug toxicity, and other eye conditions have been associated with cystoid macular edema (CME):

  • Cataract surgery - Increased frequency with complicated intraocular surgery involving the rupture of the posterior capsule or vitreous loss
  • Penetrating keratoplasty (corneal transplant)
  • Retinal surgery - Pars plana vitrectomy
  • YAG capsulotomy (rarely associated with CME)
  • Diabetes
  • Chronic renal failure
  • Hypertension (rarely)
  • Retinal vein occlusion
  • Preexisting ocular inflammation or uveitis
  • Exudative ARMD
  • Radiation exposure to eye (history of radiation to head or neck)
  • Retinitis pigmentosa
  • Epiretinal membrane
  • Systemic medications (eg, nicotinic acid, docetaxel)
  • Topical prostaglandin analogs for glaucoma (eg, latanoprost, travoprost, bimatoprost)
  • Long-term topical epinephrine or dipivefrin therapy
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Contributor Information and Disclosures
Author

David G Telander, MD, PhD  Assistant Professor, Department of Ophthalmology and Vision Science, Division of Vitreo-Retinal Diseases and Surgery, University of California Davis School of Medicine

David G Telander, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher T Cessna, DO  Vitreo-Retinal Specialist, Geisinger Health System

Christopher T Cessna, DO is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Brian A Phillpotts, MD  Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine

Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, George Alexandrakis, MD, to the development and writing of this article.

References

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Fundus photo of the right eye in a patient with cystoid macular edema.
Fluorescein angiography of the right eye (late phase) showing central macular leakage in cystic spaces around the fovea.
Optical coherence tomography (OCT) of the right eye showing central macular cystic spaces in cross-section.
Fundus photo of the right eye in a patient with cystoid macular edema from diabetic retinopathy.
Fluorescein angiography of the right eye (late phase) showing central macular leakage in cystic spaces around the fovea.
Optical coherence tomography (OCT) of the right eye showing central macular cystic spaces in cross-section.
 
 
 
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