Dujon Fuzzard, Paul Adler, Rajeev Chalasani
It is 51 years since Cystoid Macular Oedema(CME) following cataract surgery (Irvine-Gass syn-drome) was first described. Its incidence has decreaseddramatically to approximately 1% with advances insurgical technique. Irvine-Gass Syndrome poses diag-nostic and management dilemmas for ophthalmolo-gists, due to its variable time of onset post-operativelyand prognosis.
The clinical course of a patient affected byIrvine-Gass syndrome has been documented, withserial Optical Coherence Tomography (OCT) studies.
An 82 year-old male with no past ocularhistory had a cataract in the left eye (1+ cortical, 2+nuclear sclerosis) and underwent phacoemulsificationsurgery with implantation of an intraocular lens. Pre-operative best-corrected visual acuity (BCVA) was 6/9.Pre-operative OCT showed a normal macula. Thepatient received pre-operative topical diclofenac QIDfor 4 hours and a post-operative weaning regime ofchloramphenicol and diclofenac eye drops.Postoperatively at Day 9 BCVA decreased to 6/18, withminor fluorescein staining of the cornea. OCT showedno macula oedema.At Day 16 BCVA had improved to 6/9. Consequently,OCT was not performed.At Day 22 BCVA was reduced to 6/24. OCT showedclassical CME. Ketorolac eye drops 6 times per daywere commenced, and referral for medical retinaopinion was made.
Despite its decreasing incidence, IrvineGass syndrome remains an important differential diag-nosis in the evaluation of blurred vision post cataractsurgery. A normal OCT scan at one week post-operatively does not preclude its emergence. RepeatedOCT studies may be warranted where unexplainedblurred vision does not improve after cataract surgery.