8.3 Macular Oedema, Post-Operative

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Eyecare Guidelines/
Section 8 - Lens/
8.3 Macular Oedema, Post-Operative

Date of last review:

10/04/2026

Date of next review:

10/04/2028

Date of publication:

20/04/2026

Differential diagnosis ⁽¹⁾

Diabetic macular oedema
Perioperative retinal vein occlusion
Neovascular AMD
Central serous retinopathy

Possible management by optometrist

Advice ⁽¹⁾

Perform OCT imaging to confirm the diagnosis where available; if not, consider referral to a colleague with access to OCT
Be aware that mild, subclinical pseudophakic cystoid macular oedema (PCMO) often resolves spontaneously

Treatment

Early PCMO (1–4 weeks post surgery):⁽¹⁾
- If possible, discuss management with the operating surgeon or cataract provider and consider:
  - Reinstating the postoperative steroid regimen, or increasing steroid dosing ⁽¹⁾
  - Adding a topical NSAID such as Ketorolac (off label), alongside steroids ⁽¹⁾
  - Continue OCT monitoring and taper steroids as improvement occurs ⁽¹⁾
Later Presentations / Reduced Vision: ⁽¹⁾
- Initiate pharmacological therapy such as prednisolone acetate 1% or Dexamethasone 0.1% ⁽⁶⁾, with a taper guided by OCT ⁽¹⁾
- Consider adding a topical NSAID ⁽¹⁾

Typical adult dosage/duration

(Blue text = IP, black text = non-IP)

Ketorolac trometamol 0.5% eye drops ^(1,6)(POM): one drop three times daily for up to 3 weeks ^(2.3)
If patient is diabetic consider:
- Nepafenac 1mg/ml or 3mg/ml eye drops ⁽⁶⁾(POM) (refer to local guidance on dose, depending on presence of retinopathy ⁽⁷⁾): one drop three times daily (1mg/ml) or one drop once daily (3mg/ml) ⁽⁴⁾ for up to 60 days
Prednisolone acetate 1% eye dops ^(1,6) (POM): One drop ⁽⁷⁾ 4-6 times daily until inflammation is controlled, then reduce frequency (if required) ⁽⁷⁾
Dexamethasone 0.1% eye drops ⁽⁶⁾(POM): One drop 4-6 times daily until inflammation is controlled, then reduce frequency (if required) ⁽⁷⁾

NB. Monitor inflammatory response to steroid and measure IOP regularly during treatment and on completion ⁽⁷⁾

Regimens should be adjusted according to severity and patient factors (e.g. age, weight, pregnancy, renal function). Prescribing should follow local formulary and national guidance where available ⁽⁷⁾.

In cases of known sensitivities, please consult local formularies for alternative options ⁽⁷⁾.

Further management options

Observation or topical therapy is appropriate for many cases ⁽¹⁾
Treatment may be provided within available locally enhanced schemes, or by community IP Optometrists/OMPs, as appropriate ⁽⁷⁾
Refer or inform surgical team ⁽¹⁾:
- If no improvement after 4–6 weeks of topical therapy
- With high-risk patients, such as ⁽¹⁾:
  - Complicated ocular surgery
  - History of chronic PCMO in the fellow eye
  - Patients presenting with severe PCMO

Possible management in secondary care or local/community pathways where available

See further management options ^(1,7)
Management options for persistent or severe PCMO include ⁽¹⁾:
- Prophylactic intraoperative subconjunctival steroid for high-risk patients
- Postoperative NSAIDs added for high-risk groups
- Fluorescein angiography to differentiate PCMO from alternative aetiologies (e.g. diabetic macular oedema, retinal vein occlusion)
Escalation therapies for refractory cases ⁽¹⁾:
- Periocular steroid injection
- Intravitreal steroid injection or implant
- Intravitreal anti-VEGF therapy
- Topical or systemic carbonic anhydrase inhibitors

College of Optometrists Clinical Management Guideline⁽¹⁾

Pseudophakic cystoid macular oedema (PCMO) - College of Optometrists*

*With special thanks to The College of Optometrists for providing the evidence framework for diagnosis and management from the Clinical Management Guidelines (CMGs) for this condition. All references to the College/CMGs are included where appropriate and form the basis of the Community Eyecare Guidelines.

Guidance is informed by the following sources

College of Optometrists Clinical Management Guidelines Clinical Management Guidelines - College of Optometrists
Advisory alignment with the College of Optometrists Formulary Optometrists' Formulary - College of Optometrists
Advisory alignment with the BNF BNF (British National Formulary) | NICE
Advisory alignment with the Summary Product Characteristics taken from the EMC Home - electronic medicines compendium (emc)
Advisory alignment with Scottish Health Board formularies (where a clear majority is present) *
Advisory alignment with expert consensus (CEGG), informed by sources 2-5 above
Advisory alignment with expert consensus (CEGG)
“Annex C of the Statement” https://www.eyes.nhs.scot/for-professionals/legislation/

* Scottish formularies should be available within the Prescribing section of your Health Board pages on the eyes.nhs.scot website. If unavailable, contact your local Health Board for further information; Health Boards landing page

If you have a query relating to this page, please email NSS.ComEyecareGuidelineGroup@nhs.scot

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