The incidence is more common in older types of cataract surgery, where postcataract
CME could occur in 20–60% of patients,[6] but with modern cataract surgery, incidence of Irvine–Gass syndrome has reduced significantly.[7]
Replacement of the
lens as treatment for
cataract can cause pseudophakic macular edema (‘
pseudophakia’ means ‘replacement lens’). This could occur as the surgery involved sometimes irritates the
retina (and other parts of the eye) causing the
capillaries in the retina to dilate and leak fluid into the retina. This is less common today with modern lens replacement techniques.[8]
Foveolar photoreceptor damage and permanent
vision impairment can arise from multiple remissions and exacerbations of
macular edema or from persistent macular edema.[9]
Causes
Irvine–Gass syndrome usually arises after a routine
cataract operation.[10]
Risk factors
A number of systemic conditions have been linked to higher incidence of pseudophakic macular edema.[11] After cataract surgery, patients with
diabetes mellitus are generally acknowledged to have an increased risk of macular edema.[12]
A prior history of
retinal vein occlusion was the only significant preoperative risk factor in a large retrospective series of 1659 consecutive cataract surgeries.[13]
As one of the etiologic factors thought to contribute to macular edema is the release of
prostaglandins.[11]Prostaglandin analog-using patients experienced significantly more
anterior chamber flare than non-users in a randomized trial of patients with aphakic and pseudophakic glaucoma.[14]
Epiretinal membrane,[15]uveitis,[16] previous diagnosis of contralateral pseudophakic macular edema and
macular holes,[17] intraoperative iris manipulation and intraoperative capsule rupture with or without vitreous loss are other known risk factors.[18]
Treatment
Irvine–Gass Syndrome often resolves without treatment. As a first-line treatment,
corticosteroids and topical
NSAIDs are frequently used, either alone or in combination. Intravitreal administration of
corticosteroids and
anti-vascular endothelial growth factor agents may be considered if this approach proves to be ineffective.
Pars plana vitrectomy may be an option for eyes with persistent pseudophakic cystoid macular edema and vitreomacular traction.[10]
^Kiernan, Daniel F.; Hariprasad, Seenu M. (1 November 2013). "Controversies in the management of Irvine–Gass syndrome". Ophthalmic Surgery, Lasers and Imaging Retina. 44 (6): 522–527.
doi:
10.3928/23258160-20131105-01.
PMID24221459.
^Arcieri, Enyr S. (February 1, 2005). "Blood-Aqueous Barrier Changes After the Use of Prostaglandin Analogues in Patients With Pseudophakia and Aphakia". Archives of Ophthalmology. 123 (2). American Medical Association (AMA): 186–192.
doi:
10.1001/archopht.123.2.186.
ISSN0003-9950.
PMID15710814.
^Schaub, Friederike; Adler, Werner; Enders, Philip; Koenig, Meike C.; Koch, Konrad R.; Cursiefen, Claus; Kirchhof, Bernd; Heindl, Ludwig M. (2018). "Preexisting epiretinal membrane is associated with pseudophakic cystoid macular edema". Graefe's Archive for Clinical and Experimental Ophthalmology. 256 (5): 909–917.
doi:
10.1007/s00417-018-3954-4.
ISSN0721-832X.
PMID29564551.
S2CID4081172.