Irvine–Gass syndrome, pseudophakic cystoid macular edema or postcataract CME is one of the most common causes of visual loss after

cataract surgery Cataract surgery, also called lens replacement surgery, is the removal of the natural lens (anatomy), lens of the human eye, eye that has developed a cataract, an opaque or cloudy area. The eye's natural lens is usually replaced with an artific ...

. The syndrome is named in honor of S. Rodman Irvine and J. Donald M. Gass. The incidence is more common in older types of cataract surgery, where postcataract CME could occur in 20–60% of patients, but with modern cataract surgery, incidence of Irvine–Gass syndrome has reduced significantly. Replacement of the

lens A lens is a transmissive optical device that focuses or disperses a light beam by means of refraction. A simple lens consists of a single piece of transparent material, while a compound lens consists of several simple lenses (''elements'') ...

as treatment for

cataract A cataract is a cloudy area in the lens (anatomy), lens of the eye that leads to a visual impairment, decrease in vision of the eye. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colours, blurry or ...

can cause pseudophakic macular edema (‘ pseudophakia’ means ‘replacement lens’). This could occur as the surgery involved sometimes irritates the

retina The retina (; or retinas) is the innermost, photosensitivity, light-sensitive layer of tissue (biology), tissue of the eye of most vertebrates and some Mollusca, molluscs. The optics of the eye create a focus (optics), focused two-dimensional ...

(and other parts of the eye) causing the

capillaries A capillary is a small blood vessel, from 5 to 10 micrometres in diameter, and is part of the microcirculation system. Capillaries are microvessels and the smallest blood vessels in the body. They are composed of only the tunica intima (the in ...

in the retina to dilate and leak fluid into the retina. This is less common today with modern lens replacement techniques.

Signs and symptoms

Most patients have decreased or fuzzy vision.

Complications

Foveolar photoreceptor damage and permanent

vision impairment Visual or vision impairment (VI or VIP) is the partial or total inability of visual perception. In the absence of treatment such as corrective eyewear, assistive devices, and medical treatment, visual impairment may cause the individual difficul ...

can arise from multiple remissions and exacerbations of

macular edema Macular edema occurs when fluid and protein deposits collect on or under the macula of the eye (a yellow central area of the retina) and causes it to thicken and swell ( edema). The swelling may distort a person's central vision, because the ma ...

or from persistent macular edema.

Causes

Irvine–Gass syndrome usually arises after a routine

operation.

Risk factors

A number of systemic conditions have been linked to higher incidence of pseudophakic macular edema. After cataract surgery, patients with

diabetes mellitus Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained hyperglycemia, high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or th ...

are generally acknowledged to have an increased risk of macular edema. A prior history of

retinal vein occlusion Central retinal vein occlusion, also CRVO, is when the central retinal vein becomes occluded, usually through thrombosis. The central retinal vein is the venous equivalent of the central retinal artery and both may become occluded. Since the cent ...

was the only significant preoperative risk factor in a large retrospective series of 1659 consecutive cataract surgeries. As one of the etiologic factors thought to contribute to macular edema is the release of

prostaglandin Prostaglandins (PG) are a group of physiology, physiologically active lipid compounds called eicosanoids that have diverse hormone-like effects in animals. Prostaglandins have been found in almost every Tissue (biology), tissue in humans and ot ...

s. Prostaglandin analog-using patients experienced significantly more anterior chamber flare than non-users in a randomized trial of patients with aphakic and pseudophakic glaucoma.

Epiretinal membrane Epiretinal membrane or macular pucker is a disease of the eye in response to changes in the vitreous humor or more rarely, diabetes. Sometimes, as a result of immune system response to protect the retina, cells converge in the macular area as ...

uveitis Uveitis () is inflammation of the uvea, the pigmented layer of the eye between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascular structures of the eye and ...

, previous diagnosis of contralateral pseudophakic macular edema and macular holes, intraoperative iris manipulation and intraoperative capsule rupture with or without vitreous loss are other known risk factors.

Treatment

Irvine–Gass Syndrome often resolves without treatment. As a first-line treatment,

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

s and topical NSAIDs are frequently used, either alone or in combination. Intravitreal administration of

s 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.

References

External links

EyeWiki
{{DEFAULTSORT:Irvine-Gass syndrome Syndromes affecting the eye