Adaptive Optics Imaging Uncovers Photoreceptor Alterations Underlying Visual Distortion After Cystoid Macular Edema

Purpose: To describe a case of persistent visual distortion following clinical resolution of intracameral cefuroxime-induced cystoid macular edema (CME). Methods: A single case was evaluated. Results: A 68-year-old woman developed persistent visual distortion after cataract surgery with intracameral cefuroxime administration. Although optical coherence tomography (OCT) revealed only a small ellipsoid zone defect indicating near-complete recovery, adaptive optics scanning laser ophthalmoscopy (AOSLO) uncovered a pronounced fissure-like lesion coursing through the macular photoreceptor mosaic. This discrepancy demonstrated localized photoreceptor disruption that was not apparent on OCT. Conclusions: Intracameral cefuroxime-induced CME may result in lasting photoreceptor damage despite apparent anatomic recovery on OCT. This case underscores the limitations of current clinical imaging and highlights the potential of AOSLO to detect photoreceptor damage underlying persistent blurred vision after resolution of CME.