A Case of Persistent Bilateral Irvine-Gass Syndrome Following Uneventful Cataract Surgery in a Healthy Individual

TL;DR

A healthy man developed long-lasting eye swelling after cataract surgery, requiring multiple treatments to restore vision.

Contribution

This paper presents a rare case of persistent bilateral Irvine-Gass Syndrome managed through a stepwise treatment approach in the absence of standard guidelines.

Findings

Bilateral cystoid macular edema persisted for 11 months after uneventful cataract surgery.

Treatment with topical nepafenac and orbital floor triamcinolone failed to resolve the edema.

Sustained-release intravitreal dexamethasone implant successfully resolved macular edema over 120 days.

Abstract

Pseudophakic cystoid macular edema (PCME), also known as Irvine-Gass Syndrome, is one of the most common causes of postoperative visual impairment, which is usually self-limiting in nature. We report a case of persistent bilateral Irvine-Gass Syndrome (IGS) up to 11 months in a healthy individual despite an uneventful cataract surgery. A 58-year-old e-hailing male driver without any underlying systemic comorbidities complained of cloudy vision six weeks after uneventful bilateral cataract surgery. His best corrected visual acuity (BCVA) measured with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart was 6/15 OD and 6/18 OS, which were initially thought to be attributed to bilateral early-onset posterior capsule opacity. At six months postoperatively, he underwent neodymium:yttrium-aluminum-garnet (Nd:YAG) posterior capsulotomy for both eyes. BCVA slightly improved to 6/12 OU, but optical coherence tomography (OCT) of both maculae showed cystoid macular edema. Initial treatment with topical nepafenac 0.1% three times daily was prescribed for three months, but Irvine-Gass Syndrome persisted; hence, bilateral orbital floor triamcinolone (OFTA) of 40 mg/1 ml injection was given. Anti-vascular endothelial growth factor (VEGF) was not considered in this case due to cost factors. Post orbital floor triamcinolone injection, there was persistent intraretinal cystic fluid. Unfortunately, there was no gain in visual acuity due to residual cystoid macular edema. Treatment was further escalated to sustained-release intravitreal dexamethasone implant 0.7 mg for both eyes. Following the dexamethasone implant, the bilateral macular edema resolved and was maintained throughout 120 days. This case illustrates the stepwise treatment approach in this patient without the presence of a definitive management guideline.

Figures