Irvine–Gass syndrome, pseudophakic cystoid macular edema or postcataract CME is one of the most common causes of visual loss after cataract surgery.[1][2] The syndrome is named in honor of S. Rodman Irvine[3][4] and J. Donald M. Gass.[5]
| Irvine–Gass Syndrome | |
|---|---|
| Other names | Pseudophakic cystoid macular edema, Postcataract CME |
 | |
| One side of the image is clear and the other side is blurred depicting how a patient with Irvine-Gass syndrome views something with blurry eyesight | |
| Specialty | Ophthalmology |
The incidence is more common in older types of cataract surgery, where postcataract CME could occur in 20–60% of patients,[6] but with modern cataract surgery, incidence of Irvine–Gass syndrome has reduced significantly.[7]
Replacement of the lens as treatment for cataract can cause pseudophakic macular edema (‘pseudophakia’ means ‘replacement lens’). This could occur as the surgery involved sometimes irritates the retina (and other parts of the eye) causing the capillaries in the retina to dilate and leak fluid into the retina. This is less common today with modern lens replacement techniques.[8]
Signs and symptoms
editMost patients have decreased or fuzzy vision.[9]
Complications
editFoveolar photoreceptor damage and permanent vision impairment can arise from multiple remissions and exacerbations of macular edema or from persistent macular edema.[9]
Causes
editIrvine–Gass syndrome usually arises after a routine cataract operation.[10]
Risk factors
editA number of systemic conditions have been linked to higher incidence of pseudophakic macular edema.[11] After cataract surgery, patients with diabetes mellitus are generally acknowledged to have an increased risk of macular edema.[12]
A prior history of retinal vein occlusion was the only significant preoperative risk factor in a large retrospective series of 1659 consecutive cataract surgeries.[13]
As one of the etiologic factors thought to contribute to macular edema is the release of prostaglandins.[11] Prostaglandin analog-using patients experienced significantly more anterior chamber flare than non-users in a randomized trial of patients with aphakic and pseudophakic glaucoma.[14]
Epiretinal membrane,[15] uveitis,[16] previous diagnosis of contralateral pseudophakic macular edema and macular holes,[17] intraoperative iris manipulation and intraoperative capsule rupture with or without vitreous loss are other known risk factors.[18]
Treatment
editIrvine–Gass Syndrome often resolves without treatment. As a first-line treatment, corticosteroids and topical NSAIDs are frequently used, either alone or in combination. Intravitreal administration of corticosteroids and anti-vascular endothelial growth factor agents may be considered if this approach proves to be ineffective. Pars plana vitrectomy may be an option for eyes with persistent pseudophakic cystoid macular edema and vitreomacular traction.[10]
References
edit- ^ Flach, A J (1998). "The incidence, pathogenesis and treatment of cystoid macular edema following cataract surgery". Trans Am Ophthalmol Soc. 96: 557–634. PMC 1298410. PMID 10360304.
- ^ Kiernan, Daniel F.; Hariprasad, Seenu M. (1 November 2013). "Controversies in the management of Irvine–Gass syndrome". Ophthalmic Surgery, Lasers and Imaging Retina. 44 (6): 522–527. doi:10.3928/23258160-20131105-01. PMID 24221459.
- ^ Straatsma, Bradley R. (2000). "S. Rodman Irvine, MD". Transactions of the American Ophthalmological Society. 98: 9–10. PMC 1298207.
- ^ Irvine, Alexander (2000). "S. Rodman Irvine, MD (1906–1999". Archives of Ophthalmology. 118 (6): 863. doi:10.1001/archopht.118.6.863.
- ^ Flynn, Harry W.; Curtin, Victor T. (2005). "J. Donald M. Gass, MD (1928–2005)". Archives of Ophthalmology. 123 (7): 1023. doi:10.1001/archopht.123.7.1023.
- ^ Telander, David G; Cessna, Christopher T (2019-10-20). "Pseudophakic (Irvine–Gass) Macular Edema". Medscape.
- ^ Bélair, Marie-Lyne; Kim, Stephen J.; Thorne, Jennifer E.; Dunn, James P.; Kedhar, Sanjay R.; Brown, Diane M.; Jabs, Douglas A. (July 2009). "Incidence of Cystoid Macular Edema after Cataract Surgery in Patients with and without Uveitis Using Optical Coherence Tomography". American Journal of Ophthalmology. 148 (1): 128–135.e2. doi:10.1016/j.ajo.2009.02.029. PMC 2722753. PMID 19403110.
- ^ Boston, David R. Lally, MD, and Chirag P. Shah, MD, MPH. "Pseudophakic Cystoid Macular Edema". Retrieved 2017-12-13.
{{cite news}}: CS1 maint: multiple names: authors list (link) - ^ a b Telander, David G (July 19, 2021). "Pseudophakic (Irvine-Gass) Macular Edema Clinical Presentation: History, Physical, Causes". Medscape Reference. Retrieved January 11, 2024.
- ^ a b Orski, Michał; Gawęcki, Maciej (September 25, 2021). "Current Management Options in Irvine–Gass Syndrome: A Systemized Review". Journal of Clinical Medicine. 10 (19). MDPI AG: 4375. doi:10.3390/jcm10194375. ISSN 2077-0383. PMC 8509495. PMID 34640393.
- ^ a b Benitah, Nicole R.; Arroyo, Jorge G. (2010). "Pseudophakic Cystoid Macular Edema". International Ophthalmology Clinics. 50 (1). Ovid Technologies (Wolters Kluwer Health): 139–153. doi:10.1097/iio.0b013e3181c551da. ISSN 0020-8167. PMID 20057303. S2CID 2791529.
- ^ Gulkilik, Gokhan; Kocabora, Selim; Taskapili, Muhittin; Engin, Gunay (2006). "Cystoid macular edema after phacoemulsification: risk factors and effect on visual acuity". Canadian Journal of Ophthalmology. 41 (6). Elsevier BV: 699–703. doi:10.3129/i06-062. ISSN 0008-4182. PMID 17224950.
- ^ Henderson, Bonnie A.; Kim, Jae Yong; Ament, Christine S.; Ferrufino-Ponce, Zandra K.; Grabowska, Anna; Cremers, Sandra L. (2007). "Clinical pseudophakic cystoid macular edema". Journal of Cataract and Refractive Surgery. 33 (9). Ovid Technologies (Wolters Kluwer Health): 1550–1558. doi:10.1016/j.jcrs.2007.05.013. ISSN 0886-3350. PMID 17720069. S2CID 24024180.
- ^ Arcieri, Enyr S. (February 1, 2005). "Blood-Aqueous Barrier Changes After the Use of Prostaglandin Analogues in Patients With Pseudophakia and Aphakia". Archives of Ophthalmology. 123 (2). American Medical Association (AMA): 186–192. doi:10.1001/archopht.123.2.186. ISSN 0003-9950. PMID 15710814.
- ^ Schaub, Friederike; Adler, Werner; Enders, Philip; Koenig, Meike C.; Koch, Konrad R.; Cursiefen, Claus; Kirchhof, Bernd; Heindl, Ludwig M. (2018). "Preexisting epiretinal membrane is associated with pseudophakic cystoid macular edema". Graefe's Archive for Clinical and Experimental Ophthalmology. 256 (5): 909–917. doi:10.1007/s00417-018-3954-4. ISSN 0721-832X. PMID 29564551. S2CID 4081172.
- ^ Bélair, Marie-Lyne; Kim, Stephen J.; Thorne, Jennifer E.; Dunn, James P.; Kedhar, Sanjay R.; Brown, Diane M.; Jabs, Douglas A. (2009). "Incidence of Cystoid Macular Edema after Cataract Surgery in Patients with and without Uveitis Using Optical Coherence Tomography". American Journal of Ophthalmology. 148 (1). Elsevier BV: 128–135.e2. doi:10.1016/j.ajo.2009.02.029. ISSN 0002-9394. PMC 2722753. PMID 19403110.
- ^ McCafferty, Sean; Harris, April; Kew, Corin; Kassm, Tala; Lane, Lisa; Levine, Jason; Raven, Meisha (2017). "Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo". BMC Ophthalmology. 17 (1): 16. doi:10.1186/s12886-017-0405-7. ISSN 1471-2415. PMC 5319126. PMID 28219426.
- ^ Chu, Colin J.; Johnston, Robert L.; Buscombe, Charlotte; Sallam, Ahmed B.; Mohamed, Queresh; Yang, Yit C. (2016). "Risk Factors and Incidence of Macular Edema after Cataract Surgery". Ophthalmology. 123 (2). Elsevier BV: 316–323. doi:10.1016/j.ophtha.2015.10.001. hdl:1983/73a4fc2c-d912-4c13-bac8-06add67be587. ISSN 0161-6420. PMID 26681390.
Further reading
edit- Aaronson, Alexander; Achiron, Asaf; Tuuminen, Raimo (September 21, 2020). "Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac". Journal of Clinical Medicine. 9 (9). MDPI AG: 3034. doi:10.3390/jcm9093034. ISSN 2077-0383. PMC 7563612. PMID 32967137.
- Munk, Marion R.; Jampol, Lee M.; Simader, Christian; Huf, Wolfgang; Mittermüller, Tamara J.; Jaffe, Glenn J.; Schmidt-Erfurth, Ursula (October 19, 2015). "Differentiation of Diabetic Macular Edema From Pseudophakic Cystoid Macular Edema by Spectral-Domain Optical Coherence Tomography". Investigative Ophthalmology & Visual Science. 56 (11). Association for Research in Vision and Ophthalmology (ARVO): 6724–6733. doi:10.1167/iovs.15-17042. ISSN 1552-5783. PMID 26567783.