Fouad Yousef A, Karimaghaei Sam, Elhusseiny Abdelrahman M, Alagorie Ahmed R, Brown Andrew D, Sallam Ahmed B
Ophthalmology Department, Ain Shams University Hospitals, Cairo, Egypt.
Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Curr Opin Ophthalmol. 2025 Jan 1;36(1):62-69. doi: 10.1097/ICU.0000000000001101. Epub 2024 Oct 23.
Pseudophakic cystoid macular edema (PCME) is the most common postoperative complication of cataract surgery, resulting in visual decline. In this review, we discuss its pathophysiology, epidemiology, clinical presentation, and the current available evidence on therapeutic management.
Patients with diabetes mellitus have twice the risk of developing PCME as compared to nondiabetic individuals. Recent large database studies have revealed an increased risk among young, male, and black patients. A previous history of PCME is perhaps the strongest risk factor for fellow eye involvement.
PCME generally occurs around 6 weeks postoperatively and is likely a consequence of postoperative inflammation with disruption of the blood-queous and blood-retina barriers. Optical coherence tomography of the macula servers as a key diagnostic tool. There is a lack of large controlled clinical trials to guide treatment approaches. We recommend a stepwise approach for PCME that includes observation if not visually significant versus treatment with topical nonsteroidal anti-inflammatory drugs and steroids if symptomatic. Refractory cases can be treated with a periocular steroid injection, followed by intravitreal steroids if still nonresponsive.
人工晶状体性黄斑囊样水肿（PCME）是白内障手术最常见的术后并发症，可导致视力下降。在本综述中，我们讨论其病理生理学、流行病学、临床表现以及目前关于治疗管理的现有证据。
与非糖尿病患者相比，糖尿病患者发生PCME的风险高出两倍。最近的大型数据库研究显示，年轻、男性和黑人患者的风险增加。既往有PCME病史可能是对侧眼受累的最强危险因素。
PCME通常发生在术后6周左右，可能是术后炎症导致血-房水屏障和血-视网膜屏障破坏的结果。黄斑光学相干断层扫描是关键的诊断工具。缺乏大型对照临床试验来指导治疗方法。我们建议对PCME采用逐步治疗方法，即如果对视力影响不大则进行观察，而如果有症状则采用局部非甾体抗炎药和类固醇治疗。难治性病例可先进行球周类固醇注射治疗，若仍无反应则进行玻璃体内类固醇注射治疗。
