Bilateral Macular Edema

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An 80-year-old male presents for follow-up on bilateral macular edema. Initially responsive to Nevanac, the edema has now worsened despite stable BCVA at 20/30 OU.

Care1 Retina Surgeon’s Clinical Insight

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• POAG Management: Visual fields remain stable, but potential RNFL thinning and elevated IOP may require re-testing and additional IOP-lowering therapy.
• Recurrent CME: Given recurrence despite NSAID use, in-person consultation and IVFA are recommended to determine the underlying cause.
• Mild ERMs: Not likely contributing to CME, but require monitoring.

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Care1 AI’s Clinical Insight

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Cystoid Macular Edema (CME) is a leading cause of central vision loss, resulting from fluid accumulation in the retina due to blood-retinal barrier disruption. It commonly appears in conditions like diabetic macular edema, vein occlusions, post-cataract surgery (Irvine-Gass), and uveitis. OCT and FA imaging are crucial for diagnosis, revealing characteristic cystic spaces and petaloid leakage patterns. While many cases resolve within months, persistent CME may require NSAIDs, corticosteroids, CAIs, anti-VEGF therapy, or even vitrectomy for tractional cases. Recent research also challenges the long-standing myth that prostaglandin analogs significantly increase CME risk in glaucoma patients.