Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand.
Clin Exp Ophthalmol. 2019 Apr;47(3):346-356. doi: 10.1111/ceo.13513.
Pseudophakic cystoid macular oedema (PCMO) remains a significant cause of compromised postoperative vision in contemporary cataract surgery. Well-established risk factors include intraoperative complications such as posterior capsule rupture and preoperative factors including: diabetes mellitus, uveitis, retinal vein occlusion, epiretinal membrane. The role of topical glaucoma medications in PCMO continues to be debated. Current treatment strategies largely target suppression of inflammation. Topical NSAIDs remain the mainstay in prophylaxis and treatment of PCMO. Topical corticosteroids are commonly used as monotherapy or in combination with NSAIDs. Unfortunately, high-quality trials are notably lacking for other PCMO treatment modalities such as: periocular corticosteroids, orbital floor triamcinolone, intravitreal triamcinolone, corticosteroid implants, intravitreal bevacizumab and pars-plana vitrectomy. A lack of consistency in defining PCMO and resolution of PCMO explains why even large systematic reviews may come to contradictory conclusions. This review explores the varied contemporary evidence-base in relation to the aetiology, diagnosis, prophylaxis and treatment of PCMO.
后发性白内障囊样水肿(PCMO)仍然是当代白内障手术术后视力受损的一个重要原因。明确的危险因素包括术中并发症,如后囊破裂,以及术前因素,包括:糖尿病、葡萄膜炎、视网膜静脉阻塞、视网膜前膜。局部青光眼药物在 PCMO 中的作用仍存在争议。目前的治疗策略主要针对炎症抑制。局部非甾体抗炎药(NSAIDs)仍然是 PCMO 预防和治疗的主要药物。局部皮质类固醇通常单独使用或与 NSAIDs 联合使用。不幸的是,对于其他 PCMO 治疗方法,如:眼周皮质类固醇、眶底曲安奈德、玻璃体内曲安奈德、皮质类固醇植入物、玻璃体内贝伐单抗和经睫状体平坦部玻璃体切除术,高质量的试验明显缺乏。PCMO 的定义和 PCMO 消退缺乏一致性,这就是为什么即使是大型系统评价也可能得出相互矛盾的结论的原因。本文综述了与 PCMO 的病因、诊断、预防和治疗相关的各种当代循证医学证据。