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

Aim: To provide knowledge that topical steroids and topical non-steroidal antiinflammatory drugs "NSAIDs";can cure cystoid macular edema "CME"; which iscurrently mostly treated by invasive procedures "i.e. intravitreal steroids and antiVEGF, 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 oftreatment. Recently it was proved that there is an inflammatory reaction in the processof CME formation, based on that evidence many studies started aiming at evaluating therole of anti-inflammatory agents in the treatment of CME.Case presentation: A 60 years old gentleman presented with deterioration of vision inhis right eye over 45 days, he is on antiglaucoma medications and has undergone aglaucoma surgery two years back, there were no any associated systemic symptoms ordiseases. On examination: the left eye was diagnosed as end stage glaucoma and so itwas excluded from the examination; on examination of the right eye: best correctedvisual acuity was 6/36; intra ocular pressure "IOP" 10 mmHg, dilated fundusexamination: Optic disc: glaucomatous atrophy, Vessels: attenuated arterial system andcongested venous system, Macula: dull with irregular slit lamp light appearanceindicating microcysts formation; and Periphery: was non informative, Ocular CoherentTomography "OCT": showed marked increased thickness of the retinal layers with cystsformation at the macular area. Accordingly the patient was diagnosed as cystoid macularedema and hence the plan was to put him on topical steroids and topical NSAIDs eyedrops qid, a regular follow up and measurement of IOP.Results: OCT repeated after a month and there were no obvious changes, four monthslater OCT showed a remarkable improvement; i.e. the thickness is much lesser, anotherOCT after a further month showed complete resolution of the edema, and best correctedvisual acuity was 6/24.Discussion and Conclusion: CME is in part an inflammatory condition; so it couldpossibly 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 invasiveprocedures