Pseudophakic cystoid macular edema.
Pseudophakic cystoid macular edema.
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DOI：
10.1076/soph.17.3.167.14794
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发表时间：
2002-09-01
影响因子：
1.7
通讯作者：
D'Amico, Donald J
中科院分区：
文献类型：
--
作者：
Ray, Subhransu;D'Amico, Donald J
50多年来，白内障手术后黄斑囊样水肿(CME)一直被认为是导致术后视力不佳的重要原因。CME的发生率差异很大，但使用现代白内障摘除技术很可能在1-2%的范围内。CME的诊断一般可通过临床检查作出，并可通过荧光素血管造影术证实，典型的花瓣状渗漏主要进入视网膜外部。裂孔周围血管渗漏是由炎症介质引起的，导致视网膜内液体积聚和相应的视网膜功能下降。后囊破裂、玻璃体脱出、虹膜嵌顿、使用虹膜固定镜、活动性葡萄膜炎和糖尿病等与CME关系最密切的危险因素都可能增加这些介质的效力，加重术后CME。CME的治疗仍然存在争议，但一般从孤立的血管造影病例的保守观察开始，在难治性病例中通过局部使用非类固醇抗炎药(NSAIDs)、局部类固醇、眼周类固醇、全身类固醇和手术干预进行进展。更具争议性的是围手术期预防NSAID在预防临床CME中的作用。虽然数据在短期内是诱人的，但就视觉结果而言，几乎没有证据支持这种预防措施的长期好处。
Cystoid macular edema (CME) following cataract surgery has been recognized for over 50 years as an important cause of suboptimal post-operative vision. The incidence of CME varies widely, but is likely in the range of 1-2% using modern cataract extraction techniques. The diagnosis of CME can generally be made on clinical examination with evidence of perifoveal cystic spaces and can be confirmed with use of fluorescein angiography to document the classic petaloid pattern of leakage mainly into the outer retina. Leak from perifoveal vessels is induced by inflammatory mediators and results in intraretinal fluid accumulation and corresponding decrease in retinal function. The risk factors most associated with CME; rupture of posterior capsule, vitreous loss, iris incarceration, use of iris fixated lenses, active uveitis and diabetes, may all increase the potency of these mediators and exacerbate post-operative CME. The treatment of CME remains controversial but generally starts with conservative observation in isolated angiographic cases and progresses through topical non-steroidal anti-inflammatory agents (NSAIDs), topical steroids, peri-ocular steroids, systemic steroids and surgical intervention in refractory cases. Even more controversial is the role of NSAID prophylaxis peri-operatively in preventing clinical CME. Though the data is tantalizing in the short term, there is little to support the long-term benefit of such prophylaxis with respect to visual outcomes.