Persistent macular edema

[BUTTERCUP109]

I developed CME 18 months ago after surgery to implant Crystalens (clear lens extraction for presbyopia at age 48).
It was resistent to topical steroids, acular and sub-tenon triamcinolone but responded well to intravitreal triamcinolone. However, my eye pressure went up to 36 and my eyelid started to droop and it took several months before these side effects resolved. Now my CME has recurred. I am seeing a retina specialist who is very conservative in using steroids. I have had 4 intravitreal Avastin injections since April with absolutely no improvement. I'm beginning to worry about permanent consequences from CME lasting as long as 4 months. Should I have the steroid and risk glaucoma to make the CME go away, or is there some other treatment option I should try? I've read a little about somatostatin analogues (sandostatin). Advice or comments?

[John C Hagan III, MD, FACS, FAAO]

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[BUTTERCUP109]

I think the clumps of flowing "stuff" are probably vitreous floaters. Read about them and see if that doesn't sound like what you have. I too had a really bad, bad, bad floater they call a Weiss ring. It was like a big octapus drifting back and forth. I did nothing about for a year, because they said it would go away... but it did'nt. That's when I had it removed by having a vitrectomy. A month after the vitrectomy, my macular edema came back. I too use a non-steroidal eye drop, and have also had 4 shots into my eye of Avastin. Still the CME persists. My OCT has not changed in 4 months. I experience the CME as spots and distortions in my near vision.... letters look like they are melting and straight lines look jagged. Needless to say, it has me very worried.

[John C Hagan III, MD, FACS, FAAO]

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[russell903]

I, too, have Macular Edema, apparently stemming from a recent trabeculectomy/filtration surgery for glaucoma.  My vitreo/retinal specialist is treating me with Xibrom, a nonsteroidal eye drop.  I've been on them for about 3 months.  The vitreo/retinal guy says it can take up to 18 months to solve the edema.  He says my edema is waning, and took OCT tests to confirm.  But other possible aftereffects of the surgery remain-lots of lava like flowing of the vitreous, including large clumps of vaseline like bodies.  What are your visual problems from the macular edema?  

[John C Hagan III, MD, FACS, FAAO]

You cannot take either path without significant risks. CHronic CME can lead to macular cysts, holes and permanent structural damage while you understand the steroid risks. There is no clear cut answer. You will need to mull this over with your surgeon. Perhaps even get a second opinion. Have an macular OCT to see if you are forming a hole or cyst.

JCH MD