![]() ![]() Optic nerve staining is also commonly seen, and helps to distinguish pseudophakic CME from other causes of CME such as diabetic macular edema. Cystoid changes may also be apparent in the fovea and extramacular areas. ![]() On fluorescein angiography, pseudophakic CME is characterized by retinal telangiectasis, capillary dilatation, and leakage from perifoveal capillaries in the early phase frames, and perifoveal hyperfluorescent spots classically described as a “petalloid” pattern in late phase frames, representing fluorescein accumulation in cystic spaces. However, biomicroscopy may not show any abnormalities in 5-10% of eyes, making ancillary imaging studies important. Splinter hemorrhages may also be present. In severe or chronic cases, optic disc swelling and/or a lamellar hole may also be seen. These findings are best observed using a fundus contact lens, and red-free light may aide in demonstrating cystic changes. On biomicroscopy, retinal thickening and loss of the foveal depression is usually appreciated. Less common presentations include central scotomas, metamorphopsia, and mild photophobia. The most common presentation is blurry vision. The occurrence of pseudophakic CME peaks at approximately 4-6 weeks postoperatively. Similarly, while ERMs predispose eyes to CME, CME can also be a cause of ERM formation.ĭiagnosis History and Clinical Presentation RVO causes macular edema, but interestingly, patients with preexisting macular edema were excluded from the study, indicating that RVOs may induce physiologic compromise of retinal vascular in the setting of intraocular surgery. showed, while not the primary endpoint of the study, that histories of retinal vein occlusion (RVO), epiretinal membrane (ERM), and prostaglandin analogs were also associated with pseudophakic CME. In a retrospective study of 1659 cataract surgeries, Henderson et al. It is uncertain whether the results would have differed if angiographic CME were the endpoint. conducted a study of 139,759 Medicare beneficiaries who underwent modern cataract surgery, and determined that total ophthalmic payments were 47% ($1,092) higher for those who developed pseudophakic CME, compared to those who did not ( P. Furthermore, most patients with clinical CME will experience spontaneous improvement by 3 to 12 months. Most patients with CME found via angiography or OCT will not have visual changes. OCT evidence of CME after small incision phacoemulsification: 4% to 11%, but also reported to be as high as 41%.Clinical CME after small incision phacoemulsification: 0.1% to 2.35%.Angiographic CME after extracapsular cataract extraction: 15% to 30%.Angiographic CME after intracapsular cataract extraction: As high as 60%.Optical coherence tomography (OCT) definitions have also been proposed.Chronic pseudophakic CME: over 6 months.Acute pseudophakic CME: within 6 months.Clinical pseudophakic CME: associated with decreased visual acuity.Angiographic pseudophakic CME: seen on fluorescein angiography (FA).Gass and Norton subsequently studied the characteristics of the new disease entity with fluorescein angiography. In 1953, Irvine described a cystoid macular edema (CME) that specifically arose after cataract surgery. ICD-10-CM H35.359 Cystoid macular degeneration, unspecified eye ICD-9-CM 362.53 Cystoid macular degeneration, cystoid macular edema 1.1 International Classification of Diseases (ICD)ĭisease Entity International Classification of Diseases (ICD). ![]()
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