Irvine–Gass syndrome

{{Infobox medical condition (new)

| name = Irvine–Gass Syndrome

| synonyms = Pseudophakic cystoid macular edema, Postcataract CME

| image = Irvine-Gass syndrome .png

| caption = One side of the image is clear and the other side is blurred depicting how a patient with Irvine-Gass syndrome views something with blurry eyesight

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| field = Ophthalmology

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Irvine–Gass syndrome, pseudophakic cystoid macular edema or postcataract CME is one of the most common causes of visual loss after cataract surgery.{{cite journal|last1=Flach|first1=A J|title=The incidence, pathogenesis and treatment of cystoid macular edema following cataract surgery.|journal=Trans Am Ophthalmol Soc.|date=1998|pmc=1298410|pmid=10360304|volume=96|pages=557–634}}{{cite journal|last1=Kiernan|first1=Daniel F.|last2=Hariprasad|first2=Seenu M.|title=Controversies in the management of Irvine–Gass syndrome|journal=Ophthalmic Surgery, Lasers and Imaging Retina|date=1 November 2013|volume=44|issue=6|pages=522–527|doi=10.3928/23258160-20131105-01|pmid=24221459}} The syndrome is named in honor of S. Rodman Irvine{{cite journal|author=Straatsma, Bradley R.|title=S. Rodman Irvine, MD|journal=Transactions of the American Ophthalmological Society|year=2000|volume=98|pages=9–10|pmc=1298207}}{{cite journal|author=Irvine, Alexander|title=S. Rodman Irvine, MD (1906–1999|journal=Archives of Ophthalmology|volume=118|issue=6|year=2000|pages=863|doi=10.1001/archopht.118.6.863|doi-access=free}} and J. Donald M. Gass.{{cite journal|author=Flynn, Harry W.|author2=Curtin, Victor T.|title=J. Donald M. Gass, MD (1928–2005)|journal=Archives of Ophthalmology|volume=123|issue=7|year=2005|pages=1023|doi=10.1001/archopht.123.7.1023|doi-access=free}}

The incidence is more common in older types of cataract surgery, where postcataract CME could occur in 20–60% of patients,{{cite journal|last1=Telander|first1=David G|last2=Cessna|first2=Christopher T|title=Pseudophakic (Irvine–Gass) Macular Edema|url=http://emedicine.medscape.com/article/1224224-overview#showall|website=Medscape|date=2019-10-20}} but with modern cataract surgery, incidence of Irvine–Gass syndrome has reduced significantly.{{cite journal|last1=Bélair|first1=Marie-Lyne|last2=Kim|first2=Stephen J.|last3=Thorne|first3=Jennifer E. |authorlink3=Jennifer Thorne|last4=Dunn|first4=James P.|last5=Kedhar|first5=Sanjay R.|last6=Brown|first6=Diane M.|last7=Jabs|first7=Douglas A.|title=Incidence of Cystoid Macular Edema after Cataract Surgery in Patients with and without Uveitis Using Optical Coherence Tomography|journal=American Journal of Ophthalmology|date=July 2009|volume=148|issue=1|pages=128–135.e2|doi=10.1016/j.ajo.2009.02.029|pmid=19403110|pmc=2722753}}

Replacement of the lens as treatment for cataract can cause pseudophakic macular edema (‘pseudophakia’ means ‘replacement lens’). This could occur as the surgery involved sometimes irritates the retina (and other parts of the eye) causing the capillaries in the retina to dilate and leak fluid into the retina. This is less common today with modern lens replacement techniques.{{Cite news|url=http://www.reviewofophthalmology.com/content/d/retinal_insider/c/46967/|title=Pseudophakic Cystoid Macular Edema|last=Boston|first=David R. Lally, MD, and Chirag P. Shah, MD, MPH|access-date=2017-12-13}}

Signs and symptoms

Most patients have decreased or fuzzy vision.{{cite web | last=Telander | first=David G | title=Pseudophakic (Irvine-Gass) Macular Edema Clinical Presentation: History, Physical, Causes | website=Medscape Reference | date=July 19, 2021 |url=https://emedicine.medscape.com/article/1224224-clinical#showall | access-date=January 11, 2024}}

=Complications=

Foveolar photoreceptor damage and permanent vision impairment can arise from multiple remissions and exacerbations of macular edema or from persistent macular edema.

Causes

Irvine–Gass syndrome usually arises after a routine cataract operation.{{cite journal | last1=Orski | first1=Michał | last2=Gawęcki | first2=Maciej | title=Current Management Options in Irvine–Gass Syndrome: A Systemized Review | journal=Journal of Clinical Medicine | publisher=MDPI AG | volume=10 | issue=19 | date=September 25, 2021 | issn=2077-0383 | doi=10.3390/jcm10194375 | doi-access=free | page=4375| pmid=34640393 | pmc=8509495 }}

=Risk factors=

A number of systemic conditions have been linked to higher incidence of pseudophakic macular edema.{{cite journal | last1=Benitah | first1=Nicole R. | last2=Arroyo | first2=Jorge G. | title=Pseudophakic Cystoid Macular Edema | journal=International Ophthalmology Clinics | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=50 | issue=1 | year=2010 | issn=0020-8167 | doi=10.1097/iio.0b013e3181c551da | pages=139–153| pmid=20057303 | s2cid=2791529 }} After cataract surgery, patients with diabetes mellitus are generally acknowledged to have an increased risk of macular edema.{{cite journal | last1=Gulkilik | first1=Gokhan | last2=Kocabora | first2=Selim | last3=Taskapili | first3=Muhittin | last4=Engin | first4=Gunay | title=Cystoid macular edema after phacoemulsification: risk factors and effect on visual acuity | journal=Canadian Journal of Ophthalmology | publisher=Elsevier BV | volume=41 | issue=6 | year=2006 | issn=0008-4182 | doi=10.3129/i06-062 | pages=699–703| pmid=17224950 }}

A prior history of retinal vein occlusion was the only significant preoperative risk factor in a large retrospective series of 1659 consecutive cataract surgeries.{{cite journal | last1=Henderson | first1=Bonnie A. | last2=Kim | first2=Jae Yong | last3=Ament | first3=Christine S. | last4=Ferrufino-Ponce | first4=Zandra K. | last5=Grabowska | first5=Anna | last6=Cremers | first6=Sandra L. | title=Clinical pseudophakic cystoid macular edema | journal=Journal of Cataract and Refractive Surgery | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=33 | issue=9 | year=2007 | issn=0886-3350 | doi=10.1016/j.jcrs.2007.05.013 | pages=1550–1558| pmid=17720069 | s2cid=24024180 }}

As one of the etiologic factors thought to contribute to macular edema is the release of prostaglandins. Prostaglandin analog-using patients experienced significantly more anterior chamber flare than non-users in a randomized trial of patients with aphakic and pseudophakic glaucoma.{{cite journal | last=Arcieri | first=Enyr S. | title=Blood-Aqueous Barrier Changes After the Use of Prostaglandin Analogues in Patients With Pseudophakia and Aphakia | journal=Archives of Ophthalmology | publisher=American Medical Association (AMA) | volume=123 | issue=2 | date=February 1, 2005 | pages=186–192 | issn=0003-9950 | doi=10.1001/archopht.123.2.186 | pmid=15710814 }}

Epiretinal membrane,{{cite journal | last1=Schaub | first1=Friederike | last2=Adler | first2=Werner | last3=Enders | first3=Philip | last4=Koenig | first4=Meike C. | last5=Koch | first5=Konrad R. | last6=Cursiefen | first6=Claus | last7=Kirchhof | first7=Bernd | last8=Heindl | first8=Ludwig M. | title=Preexisting epiretinal membrane is associated with pseudophakic cystoid macular edema | journal=Graefe's Archive for Clinical and Experimental Ophthalmology | volume=256 | issue=5 | date=2018 | issn=0721-832X | doi=10.1007/s00417-018-3954-4 | pages=909–917| pmid=29564551 | s2cid=4081172 }} uveitis,{{cite journal | last1=Bélair | first1=Marie-Lyne | last2=Kim | first2=Stephen J. | last3=Thorne | first3=Jennifer E. | last4=Dunn | first4=James P. | last5=Kedhar | first5=Sanjay R. | last6=Brown | first6=Diane M. | last7=Jabs | first7=Douglas A. | title=Incidence of Cystoid Macular Edema after Cataract Surgery in Patients with and without Uveitis Using Optical Coherence Tomography | journal=American Journal of Ophthalmology | publisher=Elsevier BV | volume=148 | issue=1 | year=2009 | issn=0002-9394 | doi=10.1016/j.ajo.2009.02.029 | pages=128–135.e2| pmid=19403110 | pmc=2722753 }} previous diagnosis of contralateral pseudophakic macular edema and macular holes,{{cite journal | last1=McCafferty | first1=Sean | last2=Harris | first2=April | last3=Kew | first3=Corin | last4=Kassm | first4=Tala | last5=Lane | first5=Lisa | last6=Levine | first6=Jason | last7=Raven | first7=Meisha | title=Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo | journal=BMC Ophthalmology | volume=17 | issue=1 | date=2017 | issn=1471-2415 | pmid=28219426 | pmc=5319126 | doi=10.1186/s12886-017-0405-7 | doi-access=free | page=16}} intraoperative iris manipulation and intraoperative capsule rupture with or without vitreous loss are other known risk factors.{{cite journal | last1=Chu | first1=Colin J. | last2=Johnston | first2=Robert L. | last3=Buscombe | first3=Charlotte | last4=Sallam | first4=Ahmed B. | last5=Mohamed | first5=Queresh | last6=Yang | first6=Yit C. | title=Risk Factors and Incidence of Macular Edema after Cataract Surgery | journal=Ophthalmology | publisher=Elsevier BV | volume=123 | issue=2 | year=2016 | issn=0161-6420 | doi=10.1016/j.ophtha.2015.10.001 | pages=316–323| pmid=26681390 | hdl=1983/73a4fc2c-d912-4c13-bac8-06add67be587 | hdl-access=free }}

Treatment

Irvine–Gass Syndrome often resolves without treatment. As a first-line treatment, corticosteroids and topical NSAIDs are frequently used, either alone or in combination. Intravitreal administration of corticosteroids 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

[https://eyewiki.aao.org/Pseudophakic%20Cystoid%20Macular%20Edema%20(Irvine-Gass%20Syndrome) EyeWiki]

{{Medical resources

| ICD11 = {{ICD11|NA06.6Y}}

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Category:Syndromes affecting the eye