Pseudophakic cystoid macular edema

Intravitreal triamcinolone injection is safe and effective for cystoid macular edema caused by uveitis, diabetic maculopathy, and central retinal vein occlusion, and for pseudophakic cystoid macular edema. Potential risks include glaucoma, cataract, retinal detachment, and endophthalmitis. Infectious endophthalmitis is extremely rare when appropriate sterile technique is practised. Seven patients developed a clinical picture simulating endophthalmitis after intravitreal injection of triamcinolone (71). The authors believed that this effect was a toxic reaction to the injected material and explained that the differential diagnosis of infectious endophthalmitis in eyes that have been injected with triamcinolone under sterile conditions includes a sterile toxic endophthalmitis that requires careful monitoring, perhaps every 8-12 hours, in order to determine whether the inflammation is worsening or improving. Resolution occurs spontaneously, and in the absence of eye pain unnecessary intervention can be avoided. 

Hypopyon associated with non-infectious endophthalmitis after intravitreal injection of triamcinolone has been described previously (72). Pseudohypopyon and sterile endophthalmitis after intravitreal injection of triamcinolone for pseudophakic cystoid macular edema has been reported (73). 

Cupples HP Lefler WH, Pulido JS, et al. Improvement in visual acuity in chronic aphakic and pseudophakic cystoid macular edema after treatment with topical 0.5% ketorolac tromethamine.Am J Ophthalmol 1991 112 514-519. 

Kraff M, et al. Prophylaxis of pseudophakic cystoid macular edema with topical indomethacin. Ophthalmology 1982 89 885-890. 

HeierJS, Topping TM, Baumann W, et al. Ketorolac versus prednisolone versus combination therapy in the treatment of acute pseudophakic cystoid macular edema. Ophthalmology 2000 107 2034. 

Jonas JB, Kreissig I, Degeming RE Intravitreal triamcinolone acetomde for pseudophakic cystoid macular edema. AmJ Ophthalmol 2003 136 384. 

The ocular adverse effects of latanoprost include conjunctival hyperemia, iris pigmentation, periocular skin color changes, anterior uveitis, and cystoid macular edema in pseudophakic patients (77,78). H. simplex dendritic keratitis has been reported after treatment with latanoprost (79). In patients with uveitic glaucoma, latanoprost can cause increased intraocular pressure and recurrence of inflammation (80). 

Cystoid macular edema has been reported to occur in 2.8% of the patients receiving adrenaline especially in aphakic or pseudophakic eyes (13). Cystoid macular edema has also been seen after the use of dipivefrine, but in the classic case described in 1982 pretreatment with timolol maleate may have predisposed the eye to this complication (14). 

Miyake, K. Vitreous fluorophotometry in aphakic or pseudophakic eyes with persistent cystoid macular edema. Jpn J Ophthalmol 1985 29 146-152. 

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