Good Hope, Heartlands, and Solihull Eye Clinics

Cataract surgery followed by macular oedema

David Kinshuck


macular oedema after cataract surgeryMacular oedema (purple arrow).. the central retina becomes thickened like sponge enlarge


Cataract surgery is occasionally followed by this condition (1-2%). Fluid accumulates in the central retina, in the macula area, and the retina thickens like a sponge. This makes the sight blurred, a bit like looking through water. Usually the condition is found at first post-operative visit at 4 weeks, sometimes earlier.

The condition is much more likely to develop in diabetes & complicated cataract surgery and in people who smoke.

This page has been amended after a meeting September 2014. The degree of oedema is very variable: there is often  tiny amount (?20% of all cataract surgery patients) but only 1-2% have significant visual problems. In very few patients there is a lot of oedema.


Notes for professionals



post-cataract macular oedema
macular oedema diagram

2 months post-operation; oedema still present although reduced a little, vision still reduced at 6/18. Triamcinolone injection recommended.

1 month post-operation; oedema present, vision reduced at 6/24. Dexamethasone and Acular prescribed 3 times day. (Nepafenac (NEVANAC® 1 mg/ml eye drops) tid / Yellox bd now used instead as below.)

Normal profile. Blue line 4 weeks post-op; green line 8 weeks post-op enlarge




  • Mild cases seen at 2-4 weeks (6/9-6/12 vision) usually settle without treatment.
  • Drops are the first line treatment
  • After 2-4 weeks of treatment, an OCT is carried out. The oedema should be reducing at this stage, but may not have disappeared completely. Normally we wait for 4 weeks to see if there is a response to treatment, but if there is a lot of oedema, follow up time will be reduced...we examine the OCT response.
  • If the oedema has not significantly reduced,
    • some departments offer subtenons triamcinolone 40mg
    • subtenons injections
      • need a higher does of steroid than injection in the eye (this puts the blood sugar up)
      • but cause less glaucoma and fewer infections than injections in the eye,
      • but are less effective reducing the oedema than injections into the eye
    • we and others offer intravitreal triamcinolone 2mg
    • If steroid injections are used, the Nepafenac (NEVANAC® 1 mg/ml eye drops) or Yellox drops are continued, but the dexamethasone drops will not be necessary.
    • in none-diabetics we do not use antiVEGF injections see and here
  • Steroid injections, if there is no diabetic retinopathy:
  • In diabetes, if the oedema is part of diabetic retinopathy
  • Occasionally vitreous is trapped in the wound and this can be surgically removed or sometimes lasered. Retina 2012
  • All patients with macular oedema should be checked for diabetes and keep the blood pressure below 140 systolic (not diabetic), below 130 (if diabetic).
  • Prevention: high risk patients (patients with diabetes or complicated surgery, needing iris hooks, posterior capsule rupture) should be examined 2 weeks after surgery, and an OCT carried out if the vision is reduced.
  • Acular, Yellox & Nepafenac (NEVANAC® 1 mg/ml eye drops) in renal failure: we use the drops for a short time (balance of risks after discussion with our nephrologist), and dexamthasone tid.
  • Anterior chamber lens implants may cause macular oedema and may need removing.
  • A typical 'routine cataract surgery' none-diabetic patient with post-operative macular oedema
    • will be seen 4 weeks post-op
    • at this visit there will be reduced vision
    • patient will need Nepafenac (NEVANAC® 1 mg/ml eye drops) tid / Yellox bd and dexamthasone tid drops for 4 weeks
    • at the appointment 4 weeks later, the oedema will be reduced as shown by the OCT
    • then Nepafenac (NEVANAC® 1 mg/ml eye drops) / Yellox and dexamethasone will be reduced to twice daily for 4 weeks (no extra appointments are needed), and once daily for 4 weeks..the oedema will be almost gone 12 weeks post-op.

Prophylaxis, prevention

The risk of macular oedema after cataract surgery is increased in diabetes

  • 6x risk mild if mild retinopathy present
  • 12x risk  if severe retinopathy present
  • BMJ 17   COO18
  • in diabetes post-operative topical Nepafenac, intra-operative intravitreal Ranibizumab, were compared "cystoid macular edema occurred in three patients (7.9%) in Nepafenac group, one patient (2.7%) in Ranibizumab group, and seven patients (17.07%) in control group." EJO 20

If a person has had macular oedema after cataract surgery in one eye, it will usually develop when the second eye is operated on. To prevent this we usually use preventative treatment, and are now using

  • Nepafenac (NEVANAC® 1 mg/ml eye drops)  three times a day if diabetic ( or Yellox bd if not diabetic or if nepafenac not available) Pubmed  for  ~ 5 days prior to the cataract surgery in the second eye, and continue 2 weeks post-op.
  • preventative treatment is usually effective....a low blood pressure, controlling diabetes if present, and not smoking will all help to prevent the second eye developing the macula oedema.
  • linked to low antioxidant levels, hypertension, and renal disease BJO 14.
  • Thus not smoking and a healthy diet with plenty of vegetables is essential.
  • NASI systemic preop Oph 16

Prophylaxis, prevention, for professionals


Post-operative mo (macular oedema) pathway

Preop all patients

  • OCT with health care assistant
  • in particular check for epiretinal membrane

Post-op routine

  • Vision at preferred 2-4 weeks post op
  • OCT all patients if VA <6/12

Diagnose mo at 2-4 weeks post op

Next visit, generally 4 weeks later, if getting better,

  • continue drops and reduce gradually over 1-2 months

not getting better

Not diabetic

Diabetic mo > 400µ

  • offer antiVEGF treatment, as for diabetic macular oedema

Diabetic mo < 400µ



Prevention of post cataract (macular oedema = mo) pathway

Preop all patients

  • Control BP, HBA1c, smoking, macular oedema, as all increase risk of post-op mo
  • Diabetic but no none diabetic, first visit 4 weeks (?optometrist)
  • preop oct to check there is no epiretinal membrane

Preop for second eye if first eye had post-op MO

  • Control BP, HBA1c, smoking, macular oedema, as all increase risk of post-op mo
  • start ~ 5 days pre-op Yellox bd (none diabetic).
  • start ~ 5 days pre-op naphenac tid (diabetic),
  • both continue drops till 2 weeks post-op (togethe rwith the routine postoperative steroid drops)
  • OCT 2 weeks post-op

Preop uncontrolled diabetes, no mo

  • try and control diabetes and BP
  • Nepafenac (NEVANAC® 1 mg/ml eye drops) tid start ~ 5 days preop
  • continue till first post-op visit at 2 weeks (together with the routine postoperative steroid drops)

Preop severe none-proliferative or proliferative but no mo

  • try and control diabetes and BP
  • Nepafenac (NEVANAC® 1 mg/ml eye drops) tid start ~ 5 days preop & continue till first post-op visit at 2 weeks, (together with the routine postoperative steroid drops)
  • add laser PRP, start laser about 4 months preop

Diabetic mo  > 400

Diabetic mo < 400

Maculopathy but no mo