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Cystoid Macular Edema


Accumulation of fluid intra-retinally in the outer plexiform layer and inner nuclear layer due to disruption of the normal blood retinal barrier which causes leakage from perifoveal retinal capillaries and accumulation of fluid with the formation of visible cystic spaces



Risk Factors

Mnemonic ‘DEPRIVENS’

D - Diabetes (Diabetic Macular Edema)

E - Epinephrine

P - Pars planitis/ Uveitis

R - Retinits Pigmentosa and other retinal dystrophies

I - Irvine Gass Syndrome (post cataract surgery)

V - Vein occlusions

E - E2 - Prostaglandins

N - Nicotinic acid and Niacin

S - Surgery/ Laser (PPV, Cryopexy, Laser photocoagulation, Glaucoma surgery)



Fundus:

Intraretinal cysts within the foveal region of macula in Henle’s layer in a honeycomb pattern

Loss of foveal reflex




OCT:

Intraretinal central cysts- hyporeflectivity at the level of the outer plexiform layer

Loss of foveal depression

Macular thickening


FFA:

Classic ‘petalloid pattern’ or expansile dot appearance in the late phase due to leakage of perifoveal capillaries into cystoid spaces distributed radially in Henle’s layer (OPL)

Leakage from disc and retinal vessels in late phases





Treatment depends on the cause of the CME


Image from Rajan Eye Care Hospital

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