Recent kera-net discussions led me to the conclusion that embracing new technology always runs the risk of discarding effective old technology. Unfortunately the learning curve of new technology may require us to make 2 diagnosis forward but 1 diagnosis back.
Post cataract surgery cystoid macular edema (CME) is a major problem with an incidence of 1 to 10% depending on how it is defined.
Optical coherence tomography (OCT) is an advanced retinal imaging diagnositc modality believe to refine the diagnosis of this postoperative CME. Unfortunately the patient may have visual complaints with a negative OCT scan but a positive pattern of cystoid macular edema with flourescein angiography.
The patient in question had visual acuity of 20/50 - OD and OS with a monofocal intraocular lens with routine uncomplicated phacoemulsification. Think about what a multifocal intraocular lens patient would complain about with a similar or lesser amount of OCT negative, FA positive CME.
Click on the link below to see the images in the picassa web album.
The titanic was unsinkable and so is every new technology in Ophthalmology. If you look at the images on the slide show you may have seen the first iceberg hit the "new" titanic.
Special thanks to Dr. Elias Mavrofrides of the FLorida Retina Institute.
http://www.floridaretinainstitute.com/index.html
1 comment:
Agreed, Sam.
I have seen several cases of CME following technically uncomplicated phaco, where vision degrades to the typical 20/50--20/80 range with zero to minimal OCT changes but positive angiogram.
I wonder if fluid is collecting in Henle's layer, but because of the nomogram of retinal thickness, an individual's swelling flies under the radar-masked in normal values.
Perhaps a better test would be to do an OCT pre-op, and followup post op for any questions of CME.
Cheers,
Badawi
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