Question: Treating Macular Edema After Glaucoma and Cataract Surgery?

May 3, 2009

I’ve developed a macular edema after a surgery for glaucoma and cataract. I am treating this with antiinflamatory drop and diamox since 5 weeks but it’s still persisting. Please let me know if you have a better suggestion. Thanks and best regards, Bose

 

 



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2 Responses to “Question: Treating Macular Edema After Glaucoma and Cataract Surgery?”

  • Dr. Ari Weitzner

    I assume the case was uncomplicated, and there are no iol issues (like malposition, rubbing on iris) that can be addressed surgically. typically, acular/pf is the way to go- i assume that is what you are using at present. if that fails, i would seriously consider intravit injection of kenalog and/or avastin. last resort is vitrectomy/possible peel, but of course, i would reserve that for very symptomatic cme and have good informed consent in the chart.

  • In response to your macular edema, I am assuming that this is post-operative macular edema (i.e. cystoid macular edema) that developed post-operatively. I am also assuming the glaucoma surgery was for a filter or trabeculectomy, either of which could result in significant low pressure.

    Post-operative macular edema used to be more common after ECCE, but has decreased with modern phacoemulsification. The macular edema typically last less than 6 weeks, but may last much longer. Usually topical treatment with steroids and non-steroidal drops is all that it takes, but, again, this may take months. Diamox has always been controversial, in my opinion, for this condition. Sub-tenon’s injection of steroids, e.g. Triamcinolone, or intravitreal injection may be the next step.

    Glaucoma operations commonly are associated with hypotony during which choroidal effusions may develop. While this is usually not associated with macular edema, it may cause a similar course, that is, it can also cause reduced vision and take weeks to resolve.

    Lastly, I am assuming that you are not diabetic as macular edema from diabetes can be made worse from cataract surgery.

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