Case 1

Question 1a: A 67-year-old male presents to an emergency eye clinic with decreased unilateral vision loss from 20/50 to 20/100 OD since the last visit. He had cataract surgery one month prior in this right eye. His most recent HbA1C was 5.4%. The patient’s OCT is shown below. 

What abnormalities do you visualize in the patient’s OCT image?

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Correct! The answer is (D). All of the above. The abnormalities on the OCT are:

1) Loss of foveal contour and epi-retinal membrane
2) Well-defined intra-retinal cysts
3) Sub-retinal fluid.

Question 1b: What is the Diagnosis?

The Diagnosis is Cystoid Macular Edema
OCT findings associated with CME include loss of foveal depression, diffuse retinal thickening, and intra-retinal fluid as defined by areas of low reflectivity (black) that is often seen in the outer plexiform layer.

A small hypo-reflective cavity is also seen underneath the neurosensory retina indicative of sub-retinal fluid.

Question 1c: Which of the following is the most reasonable first-line therapy for the patient’s diagnosis?

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Correct! The answer is (B). Topical NSAIDs and Topical Corticosteroids.

Cystoid macular oedema (CME) can be caused by numerous underlying conditions such as diabetic retinopathy, central/branch retinal vein occlusion, uveitis, age-related macular degeneration, and post-operative phenomenon.

Given the patient’s recent history of cataract surgery, and the absence of diabetes in his past medical history, the cause of CME is likely post-operative. A combination of topical NSAIDs and corticosteroids are used in the management of postoperative CME.

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