Cystoid Macular Edema

Cystoid Macular Edema Or CME is a painless disorder which can occur after cataract surgery. The Macula or central area of the retina is responsible for reading vision. After eye surgery the macula can develop swelling just like a sponge can swell with multiple cyst like or Cystoid spaces. CME can occur initially in about one in five eyes after cataract surgery but is only visually significant in 1 to 2% of cases. If CME developed in one eye after cataract surgery than there's about a fifty percent chance of developing it in the other fellow eye after surgery. Other risk factors for the development of CME which may depend upon your general health, underlying conditions of the eye, and the technique of cataract surgery. 80 percent of cases will clear on their own after about one year. Some patients will develop CME immediately after surgery whereas other patients develop delayed CME weeks to months after surgery.

Most cases respond well to eye drops after 1-2 months. In refractory cases, that is patients who don't respond well to drops sometimes an injection of cortisone around the eye can be used. Laser is used to treat abnormal leaking vessels in some cases such as diabetic retinopathy. In more advanced cases of vitrectomy surgery is indicated especially if any ocular abnormalities detected. The best potential visual acuity after the CME resolves depends upon other associated ocular conditions. For example, if the CME resolves, but the patient has advanced macular degeneration, the vision will still be poor.

Endophthalmitis

One of the most acute and serious problems to develop is endophthalmitis or infection within the eye. Fortunately, endophthalmitis rarely occurs in more than one in 1,000 to one in 500 cataract cases. If you have progressive redness, pain, or loss of vision after surgery you should notify your surgeon immediately. Infections typically arise from bacteria which normally reside on the skin and mucous membranes around the eye. There is inflammation after any type of eye surgery; however inflammation associated with bacterial infection requires urgent treatment.

Depending on the severity of infection this may require treatment in the office or in the operating room. A small amount of fluid is removed from the eye which is used to identify the bacteria, and to determine its sensitivity to a variety of antibiotics. A bacteria can be identified in about 2/3 of the cases. Once a sample is removed one or more broad spectrum antibiotics are injected into the eye which eradicates 99 percent of known bacteria. You can expect at least three to four weeks before any significant improvement in vision. Depending on the severity of infection this may require treatment in the office or in the operating room.

In more severe cases, an operation called a vitrectomy is necessary to remove the pus from the jelly filled central cavity of the eye. At the time of surgery samples of eye fluid are sent to the laboratory and antiobiotics are injected into the eye.

There are other rare forms of inflammation in the eye which can also develop weeks to months after a cataract operation. Some cases are caused by a smoldering chronic bacterial or fungal infection. Other cases of post-operative inflammation are not related to an infection by a bacteria or fungus and often require further investigation. If either an acute or chronic endophthalmitis is suspected, your ophthalmologist will discuss treatment options with you.

Retained Lens Fragments

Another unusual problem that can develop after cataract surgery is incomplete removal of the cataract lens with retained lens fragments in the eye. Often ophthalmologists use the analogy of operating on an egg when describing cataract surgery. The Yolk and most of the White of the egg is removed leaving a clear shell or sac called the posterior capsule behind. Usually a plastic lens implant is placed within this sac. In about one in fifty cases this delicate posterior capsule may break during the cataract surgery. In a small proportion of these, part or all of the cataract can be lost into the central eye cavity. These pieces of the cataract or retained lens fragments depending upon their size and associated problems may or may not require removal from the eye by a of the vitreo-retinal surgeon. These fragments can lead to high pressure, inflammation, and swelling of the retina if not removed with in a few weeks. However not every patient with retained lens fragments requires additional surgery. A vitrectomy or removal of the jelly like substance from the eye is performed to remove these lens fragments. Usaually, 80% of patients do recover reading vision.