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Unilateral acute macular oedema with serous macular detachment following bilateral phacoemulsification: A series of two case reports

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First Author: H.Aya UK

Co Author(s):    S. Burridge   D. Kazakos   R. Asaria              

Abstract Details

Purpose:

Macular oedema with serous macular detachment has been recognised to occur acutely following uneventful phacoemulsification surgery.1–3 This appears to be a separate entity to pseudophakic cystoid macular oedema, a relatively common cause of post-operative visual decline that typically occurs 4-12 weeks following surgery.1,4 We present 2 cases of unilateral serous macular detachment and intra-retinal fluid accumulation that occurred 1 day after otherwise uneventful bilateral phacoemulsification procedures.

Setting:

These events took place post-operatively in the ophthalmology department at the Royal Free Hospital NHS Foundation Trust

Methods:

We report 2 cases of unilateral macular oedema with serous macular detachment occurring 1 day after uneventful bilateral phacoemulsification procedures. Both patients underwent sequential bilateral phacoemulsification for refractive lens exchange (RLE). On post-operative day 1, CDVA was recorded between 6/24 and 6/48 in the affected eyes of Case 1 and Case 2 respectively. In both cases, OCT showed serous macular detachment with significant intra-retinal fluid accumulation. Central foveal thickness (CFT) was recorded as 583µm in Case 1 and 822µm in Case 2.

Results:

In Case 1, the fluid was completely resorbed by post-operative day 3 with no additional treatment. Final CDVA and CFT in Case 1 were 6/6 and 292µm. Resolution of oedema was more prolonged in Case 2 but occurred by post-operative day 8, and following the addition of nepafenac 0.1% on day 2. Final CDVA and CFT in Case 2 were 6/6 and 299µm.

Conclusions:

Given the rarity of cases, optimal treatment for acute serous macular detachment following phacoemulsification surgery remains unclear. In addition to standard post-operative topical steroid, studies have reported successful outcomes with systemic acetazolamide, systemic or topical non-steroidal anti-inflammatory drugs (NSAIDs), and systemic or intra-vitreal steroids.1–3 In Case 1, complete regression of fluid was seen without any additional treatment, a similar finding to 8 cases reported by Aslankurt et al.6 In Case 2, nepafenac 0.1% was added on day 2 with complete resolution seen by day 8. Observation alone or topical NSAID therapy may therefore be suitable management in these rare cases

Financial Disclosure:

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