Real-world management of chronic pseudophakic cystoid macular oedema: a descriptive case series of treatment timelines and escalation patterns.

purposePseudophakic cystoid macular oedema (pCMO) is a common complication following cataract surgery. Chronic pCMO is defined as oedema persisting for 90 days or longer from the date of referral. No consensus currently exists regarding optimal management, resulting in considerable variability in clinical practice. This study aimed to describe current treatment approaches and timelines for chronic pCMO across the Greater Glasgow area in a descriptive, real-world case series.

methodsA retrospective case series was conducted on cases referred by community optometrists between January 2021 and December 2023 for post cataract surgery cystoid macular oedema (CMO). Inclusion criteria were OCT-confirmed oedema persisting for at least 90 days from the date of referral. Exclusion criteria included postoperative CMO attributable to other causes, resolution within 90 days, or prior fovea involving diabetic macular oedema. Electronic health records and OCT images were reviewed to confirm diagnosis, collect demographic data, treatment regimens, duration, recurrence, and adverse effects of treatment.

resultsThirty-four eyes from thirty-four patients were included in the study. The median time to resolution of chronic pCMO from diagnosis was 164 days. Median resolution times by treatment were as follows: exclusive topical therapy (ETT) 130 days; topicals plus intravitreal dexamethasone implant (TT-IDI) 177.5 days; topicals plus periocular triamcinolone acetonide (TT-PTA) 275 days; topicals plus intravitreal triamcinolone acetonide (TT-ITA) 123 days; and topicals plus intravitreal anti-VEGF (TT-AntiVEGF) 264 days. After escalation to adjuvant therapy, median resolution times were IDI 56.5 days; PTA 29 days; ITA 73 days; Anti-VEGF 124 days. Median time to escalation to adjuvant therapy was 108 days. Two patients experienced CMO recurrence at three and six months, respectively and one (2.9%) developed a steroid response.

conclusionsManagement of chronic pCMO varied substantially, with a median 108-day delay before escalation to invasive therapies, reflecting caution to escalate. Among adjuvant therapies, the shortest observed resolution times were seen with periocular triamcinolone and intravitreal dexamethasone; anti-VEGF was used infrequently and in a small, selected subgroup, limiting interpretation of its observed outcomes. A median 40-day delay between referral and treatment initiation suggests potential for improved efficiency, particularly if initial topical therapy is commenced earlier by the referring optometrist. These findings raise the hypothesis that earlier escalation to periocular or intravitreal corticosteroid therapy after 6-8 weeks of inadequate topical response may improve outcomes, although this descriptive, hypothesis-generating case series-with small, non-randomised subgroups-cannot establish comparative treatment effectiveness; prospective evaluation would be required to test this.