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