A case report on acute cystoid macular edema days after YAG laser capsulotomy

We report a unique case of cystoid macular edema occurring immediately after Neodymium-doped yttrium aluminum garnet (Nd: YAG) laser capsulotomy.

A 62-year-old gentleman began seeing wavy lines and a black dot located in his central visual field two days post-YAG. Diagnosis of cystoid macular edema was confirmed by Optical Coherence Tomography (OCT) and was treated with prednisolone acetate eye drops four times a day and Bromfenac eye drops once daily. One month post-treatment, the vision improved to a corrected distance visual acuity (CDVA) of 20/70, with the macula appearing normal and the cystoid macular edema slowly improving. There was some macular sheen present. The medication was changed to Difluprednate twice daily along with previously prescribed Bromfenac once daily, as a stronger steroid was required. On the two-month follow-up, CDVA improved to 20/25, and the CME had resolved. The patient was advised to continue prescribed medications until finished and to repeat OCT in a month. OCT was done three months post-operatively and was essentially normal with some residual perifoveal edema.

This case highlights the possibility of CME occurring immediately after YAG laser capsulotomy, resulting in sudden decrease of vision. CME is more common after cataract surgery than after YAG, and this appears to be a unique case of immediate CME post-YAG laser capsulotomy.

Our experience suggests that colleagues should consider NSAIDS pre- and post- YAG laser capsulotomy to prevent CME. This case highlights the importance of following appropriate management for CME regardless of timeframe of presentation to ensure results.