Inflammatory Disease, Preoperative Retinal Changes And Postoperative Macular Edema

In a patient with rheumatoid arthritis and hypertension, who showed subtle intraretinal cystic changes on preoperative optical coherence tomography, we present a case of cystoid macular edema developing after cataract surgery. Our aim is to highlight the importance of careful evaluation of preoperative retinal changes and the role of the underlying inflammatory milieu.

This study was prepared based on the findings obtained during the diagnosis, monitoring, and treatment of a patient who developed cystoid macular edema following cataract surgery at Dışkapı Yıldırım Beyazıt Training and Research Hospital in October 2025.

A patient with a history of hypertension and rheumatoid arthritis, receiving hydroxychloroquine, presented with decreased vision in the right eye. The left eye had undergone cataract surgery several years earlier, with two postoperative injections. Biomicroscopic examination of the right eye revealed corticonuclear and posterior subcapsular cataract, while fundus examination was unremarkable. Preoperative optical coherence tomography showed limited intraretinal cystic changes in the macular region. Cataract surgery of the right eye was subsequently planned.

On the first postoperative day, the patient’s visual acuity was fully assessed. Optical coherence tomography performed on the fifth postoperative day showed a reduction in intraretinal cystic changes. At the one-month follow-up, the patient’s visual acuity decreased to 0.4 and optical coherence tomography revealed cystoid macular edema. The patient was treated with topical nepafenac and subtenon triamcinolone acetonide injection. Following treatment, visual acuity improved and the cystoid macular edema resolved.

Cystoid macular edema is a significant postoperative complication that can reduce visual acuity and is associated with inflammatory disruption of the blood-retina barrier.Known risk factors include diabetes mellitus,uveitis,retinal vein occlusion,epiretinal membrane and surgical complications.In this case,the patient’s history of hypertension and rheumatoid arthritis,prior cataract surgery in the fellow eye with possible subtenon or intravitreal injections and preoperative OCT showing intraretinal cystic changes were identified as risk factors for postoperative cystoid macular edema.Patients with systemic inflammatory diseases and preoperative retinal changes should be closely monitored and prophylactic strategies should be considered.