Khalaff Amera Gamela, Emara Barry
Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Int J Surg Case Rep. 2025 Sep 18;136:111960. doi: 10.1016/j.ijscr.2025.111960.
We report a unique case of cystoid macular edema occurring immediately after Neodymium-doped yttrium aluminum garnet (Nd: YAG) laser capsulotomy.
A 62-year-old gentleman began seeing wavy lines and a black dot located in his central visual field two days post-YAG. Diagnosis of cystoid macular edema was confirmed by Optical Coherence Tomography (OCT) and was treated with prednisolone acetate eye drops four times a day and Bromfenac eye drops once daily. One month post-treatment, the vision improved to a corrected distance visual acuity (CDVA) of 20/70, with the macula appearing normal and the cystoid macular edema slowly improving. There was some macular sheen present. The medication was changed to Difluprednate twice daily along with previously prescribed Bromfenac once daily, as a stronger steroid was required. On the two-month follow-up, CDVA improved to 20/25, and the CME had resolved. The patient was advised to continue prescribed medications until finished and to repeat OCT in a month. OCT was done three months post-operatively and was essentially normal with some residual perifoveal edema.
This case highlights the possibility of CME occurring immediately after YAG laser capsulotomy, resulting in sudden decrease of vision. CME is more common after cataract surgery than after YAG, and this appears to be a unique case of immediate CME post-YAG laser capsulotomy.
Our experience suggests that colleagues should consider NSAIDS pre- and post- YAG laser capsulotomy to prevent CME. This case highlights the importance of following appropriate management for CME regardless of timeframe of presentation to ensure results.
我们报告了一例钕掺杂钇铝石榴石（Nd:YAG）激光晶状体后囊切开术后立即发生的黄斑囊样水肿的独特病例。
一名62岁男性在YAG激光晶状体后囊切开术后两天开始出现视野中央有波浪线和一个黑点。光学相干断层扫描（OCT）确诊为黄斑囊样水肿，给予醋酸泼尼松龙滴眼液每日4次和溴芬酸钠滴眼液每日1次治疗。治疗1个月后，视力提高到矫正远视力（CDVA）为20/70，黄斑外观正常，黄斑囊样水肿逐渐改善。黄斑区有一些光泽。由于需要更强效的类固醇，药物改为地氟泼尼龙每日2次，同时继续使用之前开具的溴芬酸钠每日1次。在2个月的随访中，CDVA提高到20/25，CME已消退。建议患者继续服用规定药物直至用完，并在1个月后复查OCT。术后3个月进行OCT检查，基本正常，仅黄斑中心凹周围有一些残留水肿。
该病例突出了YAG激光晶状体后囊切开术后立即发生CME导致视力突然下降的可能性。CME在白内障手术后比在YAG激光晶状体后囊切开术后更常见，这似乎是YAG激光晶状体后囊切开术后立即发生CME的一个独特病例。
我们的经验表明，同事们在YAG激光晶状体后囊切开术前和术后应考虑使用非甾体抗炎药以预防CME。该病例突出了无论发病时间如何，对CME进行适当管理以确保治疗效果的重要性。
