Aphakic Cystoid Macular Edema

Abstract

The entity of aphakic (or pseudophakic) cystoid macular edema (ACME) continues to be a frustrating enigma for the anterior segment surgeon. Although it is predominantly a problem following cataract extraction, cystoid macular edema is seen in patients after keratoplasty (especially those who are already aphakic or those undergoing a "combined procedure") and is also seen after vitrectomy, retinal detachment repair, discission of intraocular membranes, cyclocryotherapy, and in other situations. Certain characteristics of ACME are well established: Angiographic ACME is common (about 20% of our patients with a posterior chamber lens and an intact posterior capsule, three to six months post surgery),1 whereas visually significant ACME is much rarer. ACME is rarely seen within one or two weeks after cataract surgery, but has a peak incidence several months following surgery.2,3 Spontaneous resolution often occurs.2,3 Inflamed eyes are much more likely to develop ACME and show persistent ACME.2,3 This inflammation can be