Skip to main content
SpringerLink
Log in

Therapie des zystoiden Makulaödems bei Pseudophakie

Treatment of pseudophakic cystoid macular edema

  • Das therapeutische Prinzip
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Das funduskopisch sichtbare zystoide Makulaödem nach unkomplizierter Kataraktoperation (PZMÖ) tritt in 1–3% der Fälle auf. Es hat eine gute Prognose. Nur 10% der Ödeme persistieren über 2 Jahre hinaus. Die prophylaktische Behandlung von Augen ohne Begleiterkrankungen mit nichtsteroidalen Antiphlogistika (NSAD) und Steroiden hat keinen Einfluss auf den Endvisus. Unter bestimmten Voraussetzungen scheint sie jedoch sinnvoll. Es werden Risikofaktoren besprochen, die das Entstehen eines PZMÖ begünstigen. Der Verlauf des akuten und chronischen PZMÖ ist zwar medikamentös beeinflussbar – insgesamt ist die Studienlage, was die Behandlung dieses häufigen Problems angeht, jedoch schlecht. In diesem Zusammenhang möchten wir das Freiburger Therapieschema zum PZMÖ vorstellen.

Abstract

Pseudophakic cystoid macular edema (PCME) is the most common complication following cataract surgery. In 1–3% of cases it is associated with a decrease in visual acuity. However, PCME has a good prognosis, persisting in only 10% of the patients beyond 2 years. The prophylactic therapy of eyes without additional disease with non-steroidal antiphlogistic drugs or steroids does not influence the final visual acuity. Under certain circumstances, prophylaxis can be a reasonable option. Risk factors that promote the formation of PCME are discussed. The course of acute or chronic PCME can be influenced by drug treatment, but in general the level of evidence for the treatment of this widespread problem is low. We would therefore like to present the Freiburg treatment scheme for PCME for discussion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Benhamou N, Massin P, Haouchine B et al. (2003) Intravitreal triamcinolone for refractory pseudophakic macular edema. Am J Ophthalmol 135: 246–249

    Article  PubMed  Google Scholar 

  2. Bolz M, Michels S, Geitzenauer W et al. (2006) Effect of systemic bevacizumab therapy on retinal pigment epithelial detachment. Br J Ophthalmol [Epub ahead of print]

  3. Bradford JD, Wilkinson CP, Bradford RH Jr. (1988) Cystoid macular edema following extracapsular cataract extraction and posterior chamber intraocular lens implantation. Retina 8: 161–164

    PubMed  Google Scholar 

  4. Cordero CM, Sobrin L, Onal S et al. (2007) Intravitreal bevacizumab for treatment of uveitic macular edema. Ophthalmology [Epub ahead of print]

  5. Cox SN, Hay E, Bird AC (1988) Treatment of chronic macular edema with acetazolamide. Arch Ophthalmol 106: 1190–1195

    PubMed  Google Scholar 

  6. Farber MD, Lam S, Tessler HH et al. (1994) Reduction of macular oedema by acetazolamide in patients with chronic iridocyclitis: a randomised prospective crossover study. Br J Ophthalmol 78: 4–7

    PubMed  Google Scholar 

  7. Flach AJ (1989) Cystoid macular edema following cataract surgery. Arch Ophthalmol 107: 166–167

    PubMed  Google Scholar 

  8. Flach AJ (1998) The incidence, pathogenesis and treatment of cystoid macular edema following cataract surgery. Trans Am Ophthalmol Soc 96: 557–634

    PubMed  Google Scholar 

  9. Flach AJ, Dolan BJ, Irvine AR (1987) Effectiveness of ketorolac tromethamine 0.5% ophthalmic solution for chronic aphakic and pseudophakic cystoid macular edema. Am J Ophthalmol 103: 479–486

    PubMed  Google Scholar 

  10. Flach AJ, Graham J, Kruger LP et al. (1988) Quantitative assessment of postsurgical breakdown of the blood-aqueous barrier following administration of 0.5% ketorolac tromethamine solution. A double-masked, paired comparison with vehicle-placebo solution study. Arch Ophthalmol 106: 344–347

    PubMed  Google Scholar 

  11. Flach AJ, Jampol LM, Weinberg D et al. (1991) Improvement in visual acuity in chronic aphakic and pseudophakic cystoid macular edema after treatment with topical 0.5% ketorolac tromethamine. Am J Ophthalmol 112: 514–519

    PubMed  Google Scholar 

  12. Flach AJ, Stegman RC, Graham J et al. (1990) Prophylaxis of aphakic cystoid macular edema without corticosteroids. A paired-comparison, placebo-controlled double-masked study. Ophthalmology 97: 1253–1258

    PubMed  Google Scholar 

  13. Fung WE (1985) Vitrectomy for chronic aphakic cystoid macular edema. Results of a national, collaborative, prospective, randomized investigation. Ophthalmology 92: 1102–1111

    PubMed  Google Scholar 

  14. Gass JD, Anderson DR, Davis EB (1985) A clinical, fluorescein angiographic, and electron microscopic correlation of cystoid macular edema. Am J Ophthalmol 100: 82–86

    PubMed  Google Scholar 

  15. Gass JD, Norton EW (1966) Cystoid macular edema and papilledema following cataract extraction. A fluorescein fundoscopic and angiographic study. Arch Ophthalmol 76: 646–661

    PubMed  Google Scholar 

  16. Gass JD, Norton EW (1966) Fluorescein studies of patients with macular edema and papilledema following cataract extraction. Trans Am Ophthalmol Soc 64: 232–249

    PubMed  Google Scholar 

  17. Gehring JR (1968) Macular edema following cataract extraction. Arch Ophthalmol 80: 626–631

    PubMed  Google Scholar 

  18. Haritoglou C, Kook D, Neubauer A et al. (2006) Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema. Retina 26: 999–1005

    Article  PubMed  Google Scholar 

  19. Heier JS, Topping TM, Baumann W et al. (2000) Ketorolac versus prednisolone versus combination therapy in the treatment of acute pseudophakic cystoid macular edema. Ophthalmology 107: 2034–2038

    Article  PubMed  Google Scholar 

  20. Hitchings RA (1977) Aphakic macular oedema: a two-year follow-up study. Br J Ophthalmol 61: 628–630

    PubMed  Google Scholar 

  21. Irvine SR (1953) A newly defined vitreous syndrome following cataract surgery. Am J Ophthalmol 36: 499–619

    PubMed  Google Scholar 

  22. Jain R, Stevens JD, Bunce CV et al. (2001) Ischaemic heart disease may predispose to pseudophakic cystoid macular oedema. Eye 15: 34–38

    PubMed  Google Scholar 

  23. Jaissle GB, Ziemssen F, Petermeier K et al. (2006) Bevacizumab for treatment of macular edema secondary to retinal vein occlusion. Ophthalmologe 103: 471–475

    Article  PubMed  Google Scholar 

  24. Jonas JB, Kreissig I, Degenring R (2003) Secondary chronic open-angle glaucoma after intravitreal triamcinolone acetonide. Arch Ophthalmol 121: 729–730

    Article  PubMed  Google Scholar 

  25. Jonas JB, Kreissig I, Degenring RF (2003) Intravitreal triamcinolone acetonide for pseudophakic cystoid macular edema. Am J Ophthalmol 136: 384–386

    Article  PubMed  Google Scholar 

  26. Kraff MC, Sanders DR, Jampol LM et al. (1982) Prophylaxis of pseudophakic cystoid macular edema with topical indomethacin. Ophthalmology 89: 885–890

    PubMed  Google Scholar 

  27. Kube T, Sutter M, Trittler R et al. (2006) Carboxymethylcellulose as a new carrier substance for intravitreal injection of reproducible amounts of triamcinolone. Graefes Arch Clin Exp Ophthalmol 244: 1385–1390

    Article  PubMed  Google Scholar 

  28. Martin NF, Green WR, Martin LW (1977) Retinal phlebitis in the Irvine-Gass syndrome. Am J Ophthalmol 83: 377–386

    PubMed  Google Scholar 

  29. Mason JO III, Albert MA Jr, Vail R (2006) Intravitreal bevacizumab (Avastin) for refractory pseudophakic cystoid macular edema. Retina 26: 356–357

    Article  PubMed  Google Scholar 

  30. Melo GB, Farah ME, Aggio FB (2007) Intravitreal injection of bevacizumab for cystoid macular edema in retinitis pigmentosa. Acta Ophthalmol Scand, doi:10.1111/j.1600-0420.2006.00872.x

  31. Miyake K (1985) Vitreous fluorophotometry in aphakic or pseudophakic eyes with persistent cystoid macular edema. Jpn J Ophthalmol 29: 146–152

    PubMed  Google Scholar 

  32. Miyake K, Ibaraki N (2002) Prostaglandins and cystoid macular edema. Surv Ophthalmol (Suppl 1) 47: S203–S218

    Google Scholar 

  33. Miyake K, Ota I, Ibaraki N et al. (2001) Enhanced disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema by topical timolol and its preservative in early postoperative pseudophakia. Arch Ophthalmol 119: 387–394

    PubMed  Google Scholar 

  34. Miyake K, Ota I, Maekubo K et al. (1999) Latanoprost accelerates disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema in early postoperative pseudophakias. Arch Ophthalmol 117: 34–40

    PubMed  Google Scholar 

  35. Moldow B, Sander B, Larsen M et al. (1998) The effect of acetazolamide on passive and active transport of fluorescein across the blood-retina barrier in retinitis pigmentosa complicated by macular oedema. Graefes Arch Clin Exp Ophthalmol 236: 881–889

    Article  PubMed  Google Scholar 

  36. Peterson M, Yoshizumi MO, Hepler R et al. (1992) Topical indomethacin in the treatment of chronic cystoid macular edema. Graefes Arch Clin Exp Ophthalmol 230: 401–405

    Article  PubMed  Google Scholar 

  37. Reis A, Birnbaum F, Hansen LL et al. (2005) Cyclooxygenase-2 inhibitors: a new therapeutic option in the treatment of macular edema after cataract surgery. J Cataract Refract Surg 31: 1437–1440

    Article  PubMed  Google Scholar 

  38. Rho DS (2003) Treatment of acute pseudophakic cystoid macular edema: Diclofenac versus ketorolac. J Cataract Refract Surg 29: 2378–2384

    Article  PubMed  Google Scholar 

  39. Rossetti A, Doro D (2002) Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. J Cataract Refract Surg 28: 310–315

    Article  PubMed  Google Scholar 

  40. Sebag J, Balazs EA (1984) Pathogenesis of cystoid macular edema: an anatomic consideration of vitreoretinal adhesions. Surv Ophthalmol (Suppl) 28: 493–498

    Google Scholar 

  41. Solomon LD (1995) Efficacy of topical flurbiprofen and indomethacin in preventing pseudophakic cystoid macular edema. Flurbiprofen-CME Study Group I. J Cataract Refract Surg 21: 73–81

    PubMed  Google Scholar 

  42. Squirrell D, Bhola R, Bush J et al. (2002) A prospective, case controlled study of the natural history of diabetic retinopathy and maculopathy after uncomplicated phacoemulsification cataract surgery in patients with type 2 diabetes. Br J Ophthalmol 86: 565–571

    Article  PubMed  Google Scholar 

  43. Stahl A, Agostini HT, Hansen LL et al. (2007) Bevacizumab in retinal vein occlusion – results of a prospective case follow-up study. Graefes Arch Clin Exp Opthalmol [Epub ahead of print]

  44. Steinert RF, Puliafito CA, Kumar SR et al. (1991) Cystoid macular edema, retinal detachment, and glaucoma after Nd:YAG laser posterior capsulotomy. Am J Ophthalmol 112: 373–380

    PubMed  Google Scholar 

  45. Stern AL, Taylor DM, Dalburg LA et al. (1981) Pseudophakic cystoid maculopathy: a study of 50 cases. Ophthalmology 88: 942–946

    PubMed  Google Scholar 

  46. Wenzel M, Pham DT, Reuscher A et al. (2006) Derzeitiger Stand der Katarakt und refraktiven Chirurgie. Ophthalmo-Chirurgie 18: 207–215

    Google Scholar 

  47. Wolter JR (1981) The histopathology of cystoid macular edema. Albrecht Von Graefes Arch Klin Exp Ophthalmol 216: 85–101

    Article  PubMed  Google Scholar 

  48. Yannuzzi LA, Klein RM, Wallyn RH et al. (1977) Ineffectiveness of indomethacin in the treatment of chronic cystoid macular edema. Am J Ophthalmol 84: 517–519

    PubMed  Google Scholar 

  49. Ziemssen F, Deuter CM, Stuebiger N et al. (2007) Weak transient response of chronic uveitic macular edema to intravitreal bevacizumab (Avastin). Graefes Arch Clin Exp Ophthalmol [Epub ahead of print]

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Universitäts-Augenklinik Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland

    H.T. Agostini, L.L. Hansen & N. Feltgen

Authors
  1. H.T. Agostini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L.L. Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Feltgen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H.T. Agostini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Agostini, H., Hansen, L. & Feltgen, N. Therapie des zystoiden Makulaödems bei Pseudophakie. Ophthalmologe 104, 425–430 (2007). https://doi.org/10.1007/s00347-007-1534-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-007-1534-9

Schlüsselwörter

Keywords

Search

Navigation