Cystoid macular oedema (CMO)

Definition: Thickening of macula from breakdown of blood retinal barrier leading to accumulation of intraretinal fluid at the junction of inner nuclear layer and outer plexiform layer.


Causes:

  1. Metabolic – DR, radiation

  2. Ischaemic – RVO, DR, HTN, vasculitis, collagen dis

  3. Mechanical – VMT, ERM

  4. Inflammation – uveitis, post-op

  5. Hydrostatic – hypotony, venous occlusion

  6. Miscellaneous – macroaneurysm, telangiectasia, CNV, choroidal haemangioma, drugs (epinephrine, betaxolol, latanoprost), RP

  7. CMO like condition – XLR, nicotinic acid, OD pit, Goldmann Favre


Symptoms: loss of vision with metamorphopsia.


Investigations: OCT macula; FFA


Treatment:

  1. Observe – most cases resolve especially uncomplicated cataract surgery within 6 mths.

  2. Diamox – for RP

  3. Topical NSAIDs – for inflammatory causes. (also to consider as prophylaxis pre op for high risk cases)

  4. Topical, periocular, intravitreal or oral/IV corticosteroids – for inflammatory causes.

  5. IVT anti-VEGF – for ischaemic causes.

  6. Immunosuppressive drugs – for inflammatory causes.

  7. Grid Laser – for ischaemic causes.

  8. PPV – for mechanical causes.

 
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