Cystoid Macular Edema

This type of macular swelling is very common and even occurs after cataract surgery.

What is Cystoid Macular Edema?

Cystoid macular edema, aka CME, affects the functional center of the retina, the macula.  It is another term for macular edema where multiple cyst-like areas of swelling develop.

There are multiple causes of CME to include:

  • Retinal Vascular Occlusions (RVO)
  • Intraocular inflammation (uveitis or iritis)
  • Diabetic retinopathy
  • Uncomplicated cataract surgery

Symptoms of Cystoid Macular Edema

The main symptom of CME is blurry vision.  There may also be some symptoms of distortion, poor color perception and minification, but most patients note blurry vision.

Because this is a condition of the macula, only central vision is affected.  The peripheral or side vision is not involved.

Blurry vision can occur from a variety of eye conditions and is not a specific symptom of cystoid macular edema. 

CME after Cataract Surgery

About 1-3% of patients will develop cystoid macular edema following cataract surgery.  This can occur several weeks following uncomplicated cataract surgery.  Before modern phacoemulsification techniques evolved, CME developed in as many as 10% of patients.

For reasons unknown, fluid starts to accumulate in the macula.  Patients are often frustrated because the vision following surgery was excellent, only to get worse. 

Treatment and Prognosis

CME following cataract surgery is usually self limited, that is, there is full restoration of vision and function after several weeks of treatment.  The condition does not usually recur, but there is increased risk of developing CME in the fellow eye.

Treatment for CME following cataract surgery often involves topical anti-inflammatory eye drops.  Steroid drops are often quite effective.  In more complicated cases, injections of steroid around the eye may be helpful

Because CME can develop from other situations other than cataract surgery, treatments and prognosis vary widely.  For instance, cystoid macular edema following a branch retinal vein occlusion may involve anti-VEGF injections or depot steroids.  

Cystoid macular edema can also be caused by certain glaucoma drops or following complicated cataract surgery.  Surgery may be necessary to treat the macular swelling due to complications of cataract surgery. 

Consultation with a retinal specialist may be needed.

Diseases of the Macula | Distortion

Here’s a short list of retinal diseases that cause metamorphopsia….aka distortion.

Distortion in the vision is usually caused by a disease of the macula. The macula is the functional center of the vision. It is a small area of the retina, yet it yields the most sensitive visual acuity (i.e. 20/20) and our best color perception.

Any change in this tiny area can yield visual distortion: e.g. the perception that objects are crooked, yet we know they are straight. An example is a line of text or the straightness of a telephone pole

Causes of Distortion

There are many macular diseases that may distort the vision. Any disease that causes swelling of the macula or physically changes the macula can cause distortion.

Here’s a short list of a variety of diseases evaluated and treated by a retina specialist:

Diabetic Macular Edema – a common complication of diabetic retinopathy. The macula actually swells due to leaky blood vessels affected by diabetes.

Epiretinal Membrane – also known as macular pucker or cellophane maculpathy. A membrane actually develops on the surface of the retina causing physical distortion of the retinal surface.

Macular Hole – a distinct “stretch hole” develops in the center of the macula causing blind spots and distortion.

Macular Degeneration – either form, wet or dry, can cause distortion.

Retinal Vascular Occlusions – these include retinal vein occlusions and retinal artery occlusions. Macular edema often is associated with occlusion which may cause distortion.

Evaluation of Distortion

I usually recommend that anyone who notices a persistent change in vision, including distortion, call their eye doctor. Problems with the retina usually don’t wax and wane, thus, they don’t cause temporary or fleeting symptoms.

Any one who has complaints of distortion may need to have:

  • Dilated Eye Exam
  • Fluorescein Angiography
  • OCT – Optical Coherence Tomography

Treatment of Distortion

Treatment options are geared toward repairing the physical disruption of the retina. Vitrectomy eye surgery is indicated as in the cases of macular holes and epiretinal membranes. Macular swelling can be treated with a variety of non-surgical methods including drops, injections or laser.

If you would like to schedule an appointment, please call us (877) 245.2020.

Nader Moinfar, M.D., M.P.H.
Retina Specialist
Orlando, FL

Jon Doe