Background:
Pseudophakic cystoid macular edema (PCME) remains one of the most common visionthreatening
complication of phacoemulsification cataract surgery (PCS). Pharmacological therapy is the current
mainstay of both prophylaxis, and treatment of PCME in patients undergoing PCS. We aimed to review pharmacological
treatment options for PCME, which primarily include topical steroids, topical nonsteroidal antiinflammatory
drugs (NSAIDS), periocular and intravitreal steroids, as well as anti-vascular endothelial growth
factor therapy.
Methods:
The PubMed and Web Of Science web platforms were used to find relevant studies using the following
keywords: cataract surgery, phacoemulsification, cystoid macular edema, and pseudophakic cystoid macular
edema. Of articles retrieved by this method, all publications in English and abstracts of non-English publications
were reviewed. Other studies were also considered as a potential source of information when referenced in relevant
articles. The search revealed 193 publications. Finally 82 articles dated from 1974 to 2018 were assessed as
significant and analyzed.
Results:
Based on the current literature, we found that corticosteroids remain the mainstay of PCME prophylaxis
in uncomplicated cataract surgery, while it is still unclear if NSAID can offer additional benefits. In patients at
risk for PCME development, periocular subconjunctival injection of triamcinolone acetonide may prevent PCME
development. For PCME treatment the authors recommend a stepwise therapy: initial topical steroids and adjuvant
NSAIDs, followed by additional posterior sub-Tenon or retrobulbar corticosteroids in moderate PCME, and
intravitreal corticosteroids in recalcitrant PCME. Intravitreal anti-vascular endothelial growth factor agents may
be considered in patients unresponsive to steroid therapy at risk of elevated intraocular pressure, and with comorbid
macular disease.
Conclusion:
Therapy with topical corticosteroids and NSAIDs is the mainstay of PCME prophylaxis and treatment,
however, periocular and intravitreal steroids should be considered in refractory cases.
Relief of Cystoid Macular Edema-Induced Focal Axonal Compression with Anti-Vascular Endothelial Growth Factor Treatment
