A CARL ZEISS MEDITEC CASE REPORT SERIES

Getting to the Root of Blurred Vision Following Cataract Surgery

Presented by Jay G. Prensky, M.D., Pennsylvania Retina Specialists, PC, Camp Hill, PA.

The patient

An 80-year-old woman was referred for evaluation for cystoid macular edema (CME) following cataract surgery. She complained of persistent, blurred and distorted vision OS. Her visual acuity was 20/60 OS. The referring physician administered one intraocular and three periocular injections of triamcinolone acetonide (Kenalog) within approximately 7 months to treat the CME. In addition, he prescribed topical ketorolac tromethamine ophthalmic solution (Acular) and prednisolone acetate (Pred Forte) drops four times a day for the CME.

Unfortunately, neither the injections nor the topical drops eliminated her blurred vision. I performed a thorough exam to determine visual acuity and IOP. I also performed a slit lamp and fundus exam and biomicroscopy of the macula. After reviewing the results, I suspected the patient had an epiretinal membrane (ERM) — not CME, and I discontinued the topical medications.

Stratus OCT diagnosis

To confirm my suspicions, I used the Stratus OCT to examine the patient's retina in the left eye. Results showed that she had an ERM with foveal traction and an internal limiting membrane (ILM) (Figure 1).

It's common for patients to develop CME after cataract surgery. Many physicians assume the cause of post-surgical blurred vision is CME; however, that's not always the case.

The Stratus OCT shows an epiretinal membrane (ERM) with foveal traction (left) and an internal limiting membrane (ILM) OS. A vitrectomy was performed to remove the ERM and ILM. The retinal surface smoothed out (right) several weeks after surgery.

Treatment and outcome

I performed a sutureless vitrectomy using 25-gauge instrumentation to remove the ERM and ILM. The retinal surface smoothed out several weeks after surgery (Figure 2). In addition, the patient's visual acuity improved to 20/25 OS 3 weeks post-op.

Discussion

Using the Stratus OCT has changed the way I diagnose and treat retinal pathology. OCT had a tremendous impact in this case. What looked like CME wasn't CME. The patient still had persistent blurred vision despite previous aggressive medical treatment. With OCT, I was able to verify the cause of the patient's distorted vision more precisely. In the past, I'd used fluorescein angiography (FA) to diagnose and treat retinal pathology. However, FA has limited capabilities. Often, it provides only a speculative diagnosis versus an accurate detection of the problem that OCT offers.

The Stratus OCT allows me to show patients exactly what conditions they have and discuss the appropriate course of treatment. It also helps patients understand the nature of their condition and why they need a particular treatment. OCT is a great tool to guide my treatment decisions because it gets to the root of the problem.