Diagnosis and management of Irvine-Gass syndrome after cataract surgery: Case report of postoperative cystoid macular edema with interdisciplinary cooperation

Purpose. An 87-year-old patient presented for a final check-up and prescription of reading glasses six weeks after uncomplicated cataract surgery. The intraocular lens implanted during the operation had been selected with the aim of achieving clear distance vision. However, the final check-up revealed an unexpected reduction in distance visual acuity, which could not initially be clearly explained.

Material and Methods. The anterior segment of the eye was examined using a slit lamp (BQ 900, Haag-Streit, Köniz, Switzer­land). Best-corrected visual acuity was determined under standardized conditions using the Nidek RT 6100 refraction system (Nidek Co., Ltd., Gamagōri, Japan) with number optotypes at an ambient illumination of 100 lux. High-resolution fundus photographs were taken with the Clarus 500 (Carl Zeiss Meditec AG, Oberkochen, Germany) and optical coherence tomography was performed with the Cirrus 6000 (Carl Zeiss Meditec AG, Oberkochen, Germany) to assess the posterior segment of the eye. This was supplemented by a manual examination of the retinal periphery using a Volk 78D lens (Keeler, Windsor, UK).

Results. Imaging diagnostics and ophthalmological examination revealed cystoid macular edema in both eyes, leading to a diagnosis of Irvine-Gass syndrome. Treatment consisted of a combination of topical nonsteroidal anti-inflammatory drugs (NSAIDs), oral administration of carbonic anhydrase inhibitors, and subtenon corticosteroid injection. This treatment resulted in a significant reduction of the macular edema, accompanied by a significant improvement in visual acuity. As a result, the planned fitting and prescription of reading glasses could be successfully implemented.

Conclusion. Cystoid macular edema is a serious complication after cataract surgery and can lead to temporary vision deterioration. In most cases, vision can be restored through early diagnosis and targeted therapy.