Medical Treatment of Cystoid Macular Edema with Topical Steroids and Topical Non-Steroidal Anti-Inflammatory Drugs

Abstract

Aim: To provide knowledge that topical steroids and topical non-steroidal antiinflammatory drugs "NSAIDs";
can cure cystoid macular edema "CME"; which is
currently mostly treated by invasive procedures "i.e. intravitreal steroids and anti
VEGF, laser and vitrectomy".
Introduction: Through many years ever since the CME has been discovered by Irvin,
invasive interventions were regarded as the most effective curative modalities of
treatment. Recently it was proved that there is an inflammatory reaction in the process
of CME formation, based on that evidence many studies started aiming at evaluating the
role of anti-inflammatory agents in the treatment of CME.
Case presentation: A 60 years old gentleman presented with deterioration of vision in
his right eye over 45 days, he is on antiglaucoma medications and has undergone a
glaucoma surgery two years back, there were no any associated systemic symptoms or
diseases. On examination: the left eye was diagnosed as end stage glaucoma and so it
was excluded from the examination; on examination of the right eye: best corrected
visual acuity was 6/36; intra ocular pressure "IOP" 10 mmHg, dilated fundus
examination: Optic disc: glaucomatous atrophy, Vessels: attenuated arterial system and
congested venous system, Macula: dull with irregular slit lamp light appearance
indicating microcysts formation; and Periphery: was non informative, Ocular Coherent
Tomography "OCT": showed marked increased thickness of the retinal layers with cysts
formation at the macular area. Accordingly the patient was diagnosed as cystoid macular
edema and hence the plan was to put him on topical steroids and topical NSAIDs eye
drops qid, a regular follow up and measurement of IOP.
Results: OCT repeated after a month and there were no obvious changes, four months
later OCT showed a remarkable improvement; i.e. the thickness is much lesser, another
OCT after a further month showed complete resolution of the edema, and best corrected
visual acuity was 6/24.
Discussion and Conclusion: CME is in part an inflammatory condition; so it could
possibly be treated with anti-inflammatory agents, such as topical steroids and NSAIDs,
as it is evident in this case CME can be totally cured without the need of invasive
procedures.