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Pseudophakic cystoid macular edema associated with extrafoveal vitreoretinal traction.

Martinez MR, Ophir A - Open Ophthalmol J (2011)

Bottom Line: Excluded were eyes that either had another vitreoretinopathy that could affect the analysis or had undergone an intravitreal intervention.Three eyes (three patients) with macular edema following uneventful cataract surgery were detected to be associated with multifocal extrafoveal vitreoretinal traction sites in each.Retinal edema that was underlying each of the traction sites in all eyes was in continuum in at least one site per eye with the central macular edema, thus manifesting as diffuse macular edema.

View Article: PubMed Central - PubMed

Affiliation: Division of Ophthalmology, Hillel-Yaffe Medical Center, Hadera.

ABSTRACT

Purpose: To describe an association between extrafoveal vitreoretinal traction and intractable chronic pseudophakic cystoid macular edema (CME) by the use of optical coherence tomography (OCT).

Methods: In a retrospective case series study, charts and OCT findings of patients who had postoperative recalcitrant pseudophakic CME for at least 6 months and vitreoretinal traction membranes were analyzed. Excluded were eyes that either had another vitreoretinopathy that could affect the analysis or had undergone an intravitreal intervention.

Results: Three eyes (three patients) with macular edema following uneventful cataract surgery were detected to be associated with multifocal extrafoveal vitreoretinal traction sites in each. Retinal edema that was underlying each of the traction sites in all eyes was in continuum in at least one site per eye with the central macular edema, thus manifesting as diffuse macular edema.

Conclusion: Chronic pseudophakic macular edema may be related to extrafoveal vitreoretinal traction.

No MeSH data available.


Related in: MedlinePlus

Extrafoveal multifocal vitreoretinal traction and pseudophakic macular edema as detected by the spectral-domain OCT (Pt. 1). A + B. The clinical picture and macular map (the right circle map below the fundus picture) illustrate macular edema located centrally and inferonasally to the fovea (purple color). The yellow squares in A and B delineate the scanned area (6 x 6 mm). C + D. The B-mode presents two extrafoveal vitreoretinal traction membranes, marked by arrowhead in C and by an arrow in D. The manually marked vertical yellow lines indicate the traction sites; the OCT software automatically marks the anatomical locations in blue crosses, in A & B. Each of the underlying retinal edema sites (asterix) is in continuum with the central macula (seen in the map in A & B). E. 3-D image reconstruction reveals a relatively thick connection between the two vitreoretinal traction membranes associated with diffuse macular edema (asterix); the purple vertical line marks the foveal site. The arrowhead shows the inferior membrane (shown at C) and the arrow shows the superior one (shown in D). F. 3-D image reconstruction (area of 8.2 mm X 3 mm) includes the macula (the fovea is marked by the purple line), the superior traction site (arrow) and the optic nerve head (ONH; star). Multifocal vitreous membranes are associated with the ONH.
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Figure 1: Extrafoveal multifocal vitreoretinal traction and pseudophakic macular edema as detected by the spectral-domain OCT (Pt. 1). A + B. The clinical picture and macular map (the right circle map below the fundus picture) illustrate macular edema located centrally and inferonasally to the fovea (purple color). The yellow squares in A and B delineate the scanned area (6 x 6 mm). C + D. The B-mode presents two extrafoveal vitreoretinal traction membranes, marked by arrowhead in C and by an arrow in D. The manually marked vertical yellow lines indicate the traction sites; the OCT software automatically marks the anatomical locations in blue crosses, in A & B. Each of the underlying retinal edema sites (asterix) is in continuum with the central macula (seen in the map in A & B). E. 3-D image reconstruction reveals a relatively thick connection between the two vitreoretinal traction membranes associated with diffuse macular edema (asterix); the purple vertical line marks the foveal site. The arrowhead shows the inferior membrane (shown at C) and the arrow shows the superior one (shown in D). F. 3-D image reconstruction (area of 8.2 mm X 3 mm) includes the macula (the fovea is marked by the purple line), the superior traction site (arrow) and the optic nerve head (ONH; star). Multifocal vitreous membranes are associated with the ONH.

Mentions: Three patients, aged 51-78 years old, with chronic pseudophakic CME in one eye, in which any other potential clinical cause for the edema was not detected, were diagnosed using OCT to have extrafoveal multifocal vitreoretinal traction sites in each eye. Patients’ characteristics and OCT findings are summarized in Table 1. Both the B-mode video clips of the SD-OCT and their 3-D image reconstructions enabled fast and unambiguous detection of extrafoveal traction membranes in eyes No. 1 & 2 (Figs. 1, 2). The retinal edema that underlined each of the vitreoretinal traction sites in Eye No. 1, including the edema that was associated with the vitreopapillary traction, was in continuum with the central macular edema, thus attaining a pattern of diffuse macular edema. This observation could be depicted from the macular maps and the 3-D image reconstructions of the SD-OCT (Fig. 1 and supplementary video clip 1). Eye No. 2 had Irvine-Gass syndrome with a swollen disc at the early postoperative period. Four years later, using SD-OCT, the perifoveal area was mildly thickened, and a pseudohole at the central macula with adjacent ERM was apparent. The retinal edema that underlined one of the two detectable traction sites was in continuum with the central macular edema in that eye (Fig. 2).


Pseudophakic cystoid macular edema associated with extrafoveal vitreoretinal traction.

Martinez MR, Ophir A - Open Ophthalmol J (2011)

Extrafoveal multifocal vitreoretinal traction and pseudophakic macular edema as detected by the spectral-domain OCT (Pt. 1). A + B. The clinical picture and macular map (the right circle map below the fundus picture) illustrate macular edema located centrally and inferonasally to the fovea (purple color). The yellow squares in A and B delineate the scanned area (6 x 6 mm). C + D. The B-mode presents two extrafoveal vitreoretinal traction membranes, marked by arrowhead in C and by an arrow in D. The manually marked vertical yellow lines indicate the traction sites; the OCT software automatically marks the anatomical locations in blue crosses, in A & B. Each of the underlying retinal edema sites (asterix) is in continuum with the central macula (seen in the map in A & B). E. 3-D image reconstruction reveals a relatively thick connection between the two vitreoretinal traction membranes associated with diffuse macular edema (asterix); the purple vertical line marks the foveal site. The arrowhead shows the inferior membrane (shown at C) and the arrow shows the superior one (shown in D). F. 3-D image reconstruction (area of 8.2 mm X 3 mm) includes the macula (the fovea is marked by the purple line), the superior traction site (arrow) and the optic nerve head (ONH; star). Multifocal vitreous membranes are associated with the ONH.
© Copyright Policy - open-access
Related In: Results  -  Collection

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Figure 1: Extrafoveal multifocal vitreoretinal traction and pseudophakic macular edema as detected by the spectral-domain OCT (Pt. 1). A + B. The clinical picture and macular map (the right circle map below the fundus picture) illustrate macular edema located centrally and inferonasally to the fovea (purple color). The yellow squares in A and B delineate the scanned area (6 x 6 mm). C + D. The B-mode presents two extrafoveal vitreoretinal traction membranes, marked by arrowhead in C and by an arrow in D. The manually marked vertical yellow lines indicate the traction sites; the OCT software automatically marks the anatomical locations in blue crosses, in A & B. Each of the underlying retinal edema sites (asterix) is in continuum with the central macula (seen in the map in A & B). E. 3-D image reconstruction reveals a relatively thick connection between the two vitreoretinal traction membranes associated with diffuse macular edema (asterix); the purple vertical line marks the foveal site. The arrowhead shows the inferior membrane (shown at C) and the arrow shows the superior one (shown in D). F. 3-D image reconstruction (area of 8.2 mm X 3 mm) includes the macula (the fovea is marked by the purple line), the superior traction site (arrow) and the optic nerve head (ONH; star). Multifocal vitreous membranes are associated with the ONH.
Mentions: Three patients, aged 51-78 years old, with chronic pseudophakic CME in one eye, in which any other potential clinical cause for the edema was not detected, were diagnosed using OCT to have extrafoveal multifocal vitreoretinal traction sites in each eye. Patients’ characteristics and OCT findings are summarized in Table 1. Both the B-mode video clips of the SD-OCT and their 3-D image reconstructions enabled fast and unambiguous detection of extrafoveal traction membranes in eyes No. 1 & 2 (Figs. 1, 2). The retinal edema that underlined each of the vitreoretinal traction sites in Eye No. 1, including the edema that was associated with the vitreopapillary traction, was in continuum with the central macular edema, thus attaining a pattern of diffuse macular edema. This observation could be depicted from the macular maps and the 3-D image reconstructions of the SD-OCT (Fig. 1 and supplementary video clip 1). Eye No. 2 had Irvine-Gass syndrome with a swollen disc at the early postoperative period. Four years later, using SD-OCT, the perifoveal area was mildly thickened, and a pseudohole at the central macula with adjacent ERM was apparent. The retinal edema that underlined one of the two detectable traction sites was in continuum with the central macular edema in that eye (Fig. 2).

Bottom Line: Excluded were eyes that either had another vitreoretinopathy that could affect the analysis or had undergone an intravitreal intervention.Three eyes (three patients) with macular edema following uneventful cataract surgery were detected to be associated with multifocal extrafoveal vitreoretinal traction sites in each.Retinal edema that was underlying each of the traction sites in all eyes was in continuum in at least one site per eye with the central macular edema, thus manifesting as diffuse macular edema.

View Article: PubMed Central - PubMed

Affiliation: Division of Ophthalmology, Hillel-Yaffe Medical Center, Hadera.

ABSTRACT

Purpose: To describe an association between extrafoveal vitreoretinal traction and intractable chronic pseudophakic cystoid macular edema (CME) by the use of optical coherence tomography (OCT).

Methods: In a retrospective case series study, charts and OCT findings of patients who had postoperative recalcitrant pseudophakic CME for at least 6 months and vitreoretinal traction membranes were analyzed. Excluded were eyes that either had another vitreoretinopathy that could affect the analysis or had undergone an intravitreal intervention.

Results: Three eyes (three patients) with macular edema following uneventful cataract surgery were detected to be associated with multifocal extrafoveal vitreoretinal traction sites in each. Retinal edema that was underlying each of the traction sites in all eyes was in continuum in at least one site per eye with the central macular edema, thus manifesting as diffuse macular edema.

Conclusion: Chronic pseudophakic macular edema may be related to extrafoveal vitreoretinal traction.

No MeSH data available.


Related in: MedlinePlus