Pseudophakic (Irvine-Gass) Macular Edema Clinical Presentation

Updated: Sep 25, 2018
  • Author: David G Telander, MD, PhD; Chief Editor: Michael Taravella, MD  more...
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Presentation

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. Medication history is important to rule out potential toxic maculopathy from such agents as niacin, Avandia (in diabetics) or fingolimod (Gilenya®). Topical prostaglandins have also been associated with pseudophakic CME. [12] The need to stop prostaglandin use prophylactically has not been established. [13]

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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

  • Hypertension (rarely)

  • Preexisting ocular inflammation or uveitis

  • Radiation exposure to eye (history of radiation to head or neck)

  • 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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Complications

Persistent macular edema or multiple remissions and exacerbations can result in foveolar photoreceptor damage with permanent impairment of vision.

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