eMedicine Specialties > Ophthalmology > Retina

Nonpseudophakic Cystoid Macular Edema: Differential Diagnoses & Workup

Author: Daniel B Roth, MD, Assistant Clinical Professor, Department of Ophthalmology, University of Medicine and Dentistry of New Jersey
Contributor Information and Disclosures

Updated: Jan 4, 2008

Differential Diagnoses

Branch Retinal Vein Occlusion
Central Retinal Vein Occlusion
Corneal Edema, Postoperative
Macular Edema, Diabetic
Macular Edema, Irvine-Gass
Uveitis, Evaluation and Treatment

Workup

Laboratory Studies

  • Laboratory studies for CME vary depending on the presumed etiology of the edema.
    • If findings suggestive of diabetes are present, the patient should have blood glucose testing or a glucose tolerance test.
    • In the presence of uveitis, an appropriate evaluation for chronic uveitis should be initiated. See Uveitis, Evaluation and Treatment for details.

Imaging Studies

  • OCT is the criterion standard in the identification of CME.  OCT is a noninvasive imaging modality that can determine the presence of CME by visualizing the fluid-filled spaces in the retina. The amount of CME can be monitored over time by quantifying the area of cystoid spaces on a cross-sectional image through the macula.
    • Studies have reported OCT to be comparable to FA in the evaluation of CME, especially with newer, high-resolution OCT scanners.  OCT is beneficial by quantifying the thickness of the retina and by allowing quantitative measurements of macular edema over time. This noninvasive method is especially useful in monitoring the response to treatment.
    • Newer software for OCT has increased the resolution of this imaging modality and has led to the identification of specific patterns of CME.
  • FA is an alternative imaging study to evaluate CME. Fluid accumulation may be delayed in certain conditions; thus, late phase fluorescein photos, sometimes as long as 20 minutes or more, may be required to properly evaluate the CME. Associated findings on FA may help determine the etiology of CME.
    • If leaking microaneurysms are present in the setting of diabetic retinopathy, then diabetes likely is the cause.
    • Vascular collaterals crossing the horizontal raphe on FA can help determine that the etiology of the edema (and retinal hemorrhages if present) is likely due to a vascular occlusion.
    • The absence of leakage from CME on FA suggests a diagnosis of nicotinic acid retinopathy, Goldmann-Favre disease, or X-linked juvenile retinoschisis.
    • FA also is helpful to verify the presence of CME when it is difficult to establish clinically.

Other Tests

  • In the appropriate clinical setting, an electroretinogram may be indicated to confirm a diagnosis of RP with associated CME.

Procedures

  • Occasionally, in cases of uveitis with associated CME, a diagnostic vitreous biopsy or vitrectomy can aid in determining the correct diagnosis. The vitreous fluid can be sent for the appropriate laboratory tests based upon the clinical picture. It is beyond the scope of this article to discuss the full laboratory workup for uveitis.
  • In cases of orbital pseudotumor, an incisional biopsy for the purpose of confirming a diagnosis is indicated; however, CME rarely is associated with this condition.

More on Nonpseudophakic Cystoid Macular Edema

Overview: Nonpseudophakic Cystoid Macular Edema
Differential Diagnoses & Workup: Nonpseudophakic Cystoid Macular Edema
Treatment & Medication: Nonpseudophakic Cystoid Macular Edema
Follow-up: Nonpseudophakic Cystoid Macular Edema
Multimedia: Nonpseudophakic Cystoid Macular Edema
References
[ CLOSE WINDOW ]

References

  1. Moroi SE, Gottfredsdottir MS, Schteingart MT, Elner SG, Lee CM, Schertzer RM, et al. Cystoid macular edema associated with latanoprost therapy in a case series of patients with glaucoma and ocular hypertension. Ophthalmology. May 1999;106(5):1024-9. [Medline].

  2. Altintas O, Yuksel N, Karabas VL, Demirci G. Cystoid macular edema associated with latanoprost after uncomplicated cataract surgery. Eur J Ophthalmol. Jan-Feb 2005;15(1):158-61. [Medline].

  3. Antcliff RJ, Spalton DJ, Stanford MR, Graham EM, ffytche TJ, Marshall J. Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study. Ophthalmology. Apr 2001;108(4):765-72. [Medline].

  4. Boscia F, Furino C, Dammacco R. Intravitreal triamcinolone acetonide in refractory pseudophakic cystoid macular edema: functional and anatomic results. Eur J Ophthalmol. Jan-Feb 2005;15(1):89-95. [Medline].

  5. Callanan D, Fellman RL, Savage JA. Latanoprost-associated cystoid macular edema. Am J Ophthalmol. Jul 1998;126(1):134-5. [Medline].

  6. Conway MD, Canakis C, Livir-Rallatos C. Intravitreal triamcinolone acetonide for refractory chronic pseudophakic cystoid macular edema. J Cataract Refract Surg. Jan 2003;29(1):27-33. [Medline].

  7. Falcone PM. Vitreomacular traction syndrome confused with pseudophakic cystoid macular edema. Ophthalmic Surg Lasers. May 1996;27(5):392-4. [Medline].

  8. Feldman RB, Mayo SS, Robertson DM, Jones JD, Rostvold JA. Epiretinal membranes and cystoid macular edema in gyrate atrophy of the choroid and retina. Retina. 1989;9(2):139-42. [Medline].

  9. Fung WE. Retina. In: Other causes of cystoid macular edema and retinal trauma after surgery. 2(2). 1994:1811-7.

  10. Gregori NZ, Rosenfeld PJ, Puliafito CA, Flynn HW Jr, Lee JE, Mavrofrides EC, et al. One-year safety and efficacy of intravitreal triamcinolone acetonide for the management of macular edema secondary to central retinal vein occlusion. Retina. Oct 2006;26(8):889-95. [Medline].

  11. Halperin LS, Goldman HB. Cystoid macular edema associated with topical echothiophate iodide. Ann Ophthalmol. Dec 1993;25(12):457-8. [Medline].

  12. Heckenlively JR, Jordan BL, Aptsiauri N. Association of antiretinal antibodies and cystoid macular edema in patients with retinitis pigmentosa. Am J Ophthalmol. May 1999;127(5):565-73. [Medline].

  13. Heier JS, Steinert RF, Frederick AR Jr. Cystoid macular edema associated with latanoprost use. Arch Ophthalmol. May 1998;116(5):680-2. [Medline].

  14. Hirakawa H, Iijima H, Gohdo T, Tsukahara S. Optical coherence tomography of cystoid macular edema associated with retinitis pigmentosa. Am J Ophthalmol. Aug 1999;128(2):185-91. [Medline].

  15. Igarashi H, Igarashi S, Ishiko S, Fukui K, Yoshida A. Cystoid macular edema as an initial symptom of inflammatory orbital pseudotumor. Ophthalmologica. 1997;211(4):236-41. [Medline].

  16. Ikeda T, Sato K, Katano T, Hayashi Y. Attached posterior hyaloid membrane and the pathogenesis of honeycombed cystoid macular edema in patients with diabetes. Am J Ophthalmol. Apr 1999;127(4):478-9. [Medline].

  17. Ip MS, Gottlieb JL, Kahana A, Scott IU, Altaweel MM, Blodi BA, et al. Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion. Arch Ophthalmol. Aug 2004;122(8):1131-6. [Medline].

  18. Jonas JB, Akkoyun I, Kamppeter B, Kreissig I, Degenring RF. Branch retinal vein occlusion treated by intravitreal triamcinolone acetonide. Eye. Jan 2005;19(1):65-71. [Medline].

  19. Kersten AJ, Althaus C, Best J, Sundmacher R. Cystoid macular edema following immune recovery and treatment with cidofovir for cytomegalovirus retinitis. Graefes Arch Clin Exp Ophthalmol. Nov 1999;237(11):893-6. [Medline].

  20. Kim BY, Smith SD, Kaiser PK. Optical coherence tomographic patterns of diabetic macular edema. Am J Ophthalmol. Sep 2006;142(3):405-12. [Medline].

  21. Lee ST, Friedman SM, Rubin ML. Cystoid macular edema secondary to juxtafoveolar telangiectasis in Coats' disease. Ophthalmic Surg. Apr 1991;22(4):218-21. [Medline].

  22. Loeffler KU, Li ZL, Fishman GA, Tso MO. Dominantly inherited cystoid macular edema. A histopathologic study. Ophthalmology. Sep 1992;99(9):1385-92. [Medline].

  23. Maguire AM, Nichols CW, Crooks GW. Visual loss in cytomegalovirus retinitis caused by cystoid macular edema in patients without the acquired immune deficiency syndrome. Ophthalmology. Apr 1996;103(4):601-5. [Medline].

  24. McDonnell PJ, Ryan SJ, Walonker AF, Miller-Scholte A. Prediction of visual acuity recovery in cystoid macular edema. Ophthalmic Surg. May 1992;23(5):354-8. [Medline].

  25. Meyer CH. Current treatment approaches in diabetic macular edema. Ophthalmologica. 2007;221(2):118-31. [Medline].

  26. Michael JC, De Venecia G. Retinal trypsin digest study of cystoid macular edema associated with peripheral choroidal melanoma. Am J Ophthalmol. Feb 1995;119(2):152-6. [Medline].

  27. Mishima H, Masuda K, Miyake K. The putative role of prostaglandins in cystoid macular edema. Prog Clin Biol Res. 1989;312:251-64. [Medline].

  28. Park CH, Jaffe GJ, Fekrat S. Intravitreal triamcinolone acetonide in eyes with cystoid macular edema associated with central retinal vein occlusion. Am J Ophthalmol. Sep 2003;136(3):419-25. [Medline].

  29. Park DW, Folk JC, Whitcup SM, Polk TD, Kansupada K, Fountain C, et al. Phakic patients with cystoid macular edema, retinal periphlebitis, and vitreous inflammation. Arch Ophthalmol. Aug 1998;116(8):1025-9. [Medline].

  30. Rabena MD, Pieramici DJ, Castellarin AA, Nasir MA, Avery RL. Intravitreal bevacizumab (Avastin) in the treatment of macular edema secondary to branch retinal vein occlusion. Retina. Apr-May 2007;27(4):419-25. [Medline].

  31. Remky A, Beausencourt E, Hartnett ME, Trempe CL, Arend O, Elsner AE. Infrared imaging of cystoid macular edema. Graefes Arch Clin Exp Ophthalmol. Nov 1999;237(11):897-901. [Medline].

  32. Rocha G, Deschênes J. Pathophysiology and treatment of cystoid macular edema. Can J Ophthalmol. Oct 1996;31(6):282-8. [Medline].

  33. Rumelt S, Kraus E, Rehany U. Retinal neovascularization and cystoid macular edema in punctata albescens retinopathy. Am J Ophthalmol. Oct 15 1992;114(4):507-8. [Medline].

  34. Schubert HD. Cystoid macular edema: the apparent role of mechanical factors. Prog Clin Biol Res. 1989;312:277-91. [Medline].

  35. Silverstein BE, Smith JH, Sykes SO, Jones MR, Schwartz D, Cunningham ET Jr. Cystoid macular edema associated with cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol. Mar 1998;125(3):411-5. [Medline].

  36. Thach AB, Dugel PU, Flindall RJ, Sipperley JO, Sneed SR. A comparison of retrobulbar versus sub-Tenon's corticosteroid therapy for cystoid macular edema refractory to topical medications. Ophthalmology. Dec 1997;104(12):2003-8. [Medline].

  37. van Kooij B, Rothova A, de Vries P. The pros and cons of intravitreal triamcinolone injections for uveitis and inflammatory cystoid macular edema. Ocul Immunol Inflamm. Apr 2006;14(2):73-85. [Medline].

  38. Weene LE. Cystoid macular edema after scleral buckling responsive to acetazolamide. Ann Ophthalmol. Nov 1992;24(11):423-4. [Medline].

  39. Welzl-Hinterkorner E, Tholen H, Sturmer J, Opravil M, Bernauer W. [Bilateral cystoid macular edema after successful treatment of AIDS-associated cytomegalovirus retinitis]. Ophthalmologe. Feb 1999;96(2):87-91. [Medline].

  40. Whitcup SM, Csaky KG, Podgor MJ, Chew EY, Perry CH, Nussenblatt RB. A randomized, masked, cross-over trial of acetazolamide for cystoid macular edema in patients with uveitis. Ophthalmology. Jul 1996;103(7):1054-62; discussion 1062-3. [Medline].

  41. Yepremyan M, Wertz FD, Tivnan T, Eversman L, Marx JL. Early treatment of cystoid macular edema secondary to branch retinal vein occlusion with intravitreal triamcinolone acetonide. Ophthalmic Surg Lasers Imaging. Jan-Feb 2005;36(1):30-6. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

nonpseudophakic CME, cystoid macular edema, CME, macular edema, non-pseudophakic cystoid macular edema, non-pseudophakic CME, Irvine-Gass syndrome, macula, vision loss

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Daniel B Roth, MD, Assistant Clinical Professor, Department of Ophthalmology, University of Medicine and Dentistry of New Jersey
Daniel B Roth, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Retina Specialists
Disclosure: Nothing to disclose.

Medical Editor

Vytautas A Pakainis, MD, Chief of Ophthalmology, Dorn Veterans Administration Medical Center, Professor of Ophthalmology, Ophthalmology, University of South Carolina School of Medicine
Vytautas A Pakainis, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
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

CME Editor

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.