Bilateral Cystoid Macular Edema After Light Treatment With Light-Adjustable Lens

Light-adjustable lenses (LALs) allow for visual acuity (VA) adjustment after cataract surgery, using ultraviolet (UV) light therapy. UV-induced cystoid macular edema (CME) is not well documented. We report the first case of bilateral CME after UV light therapy with LAL. An 81-year-old woman underwent uncomplicated staged bilateral cataract extraction with LAL implantation. Two days after the second UV light adjustment, she had bilateral decreased VA and a new-onset bilateral CME. UV treatments were halted, and she was started on topical nonsteroidal anti-inflammatory drug (NSAID) therapy and prednisolone. CME completely resolved within three weeks following onset. Topical NSAID and prednisone drops were continued until the completion of all light treatments, followed by a slow taper over one month. We hypothesize that UV light can contribute to CME via multiple mechanisms, including UV-activated macromer byproducts, direct UV-induced injury, or ultraviolet B (UVB) disrupting the blood-aqueous barrier. Clinicians should be aware of this complication and maintain a low threshold for deferring light therapy and initiating topical treatment.