<prompt> A 70-year-old man presents with deterioration of vision 3 weeks after cataract extraction and IOL implantation. Slit lamp examination shows honeycomb maculopathy and Fluorescin angiography FA shows flower petal hyperfluorescence. The most likely diagnosis is:Age related macular degeneration ARMDCentral serous Retinopathy CSRMacular DystrophyCystoid Macular Edema  <response>: D i.e. Cystoid Macular Edema - Delayed onset unexpected visual loss, typically with onset in 3-4 weeks postoperatively, presenting as decreased central visual acuity with yellow spot in fovea, honey comb appearance on slit lamp examination, and flower petal or petaloid pattern hyper fluorescence on FA after cataract surgery is characteristic of cystoids maculr oedema CMO. FA in central serous chorioretinopathy gives smoke stack and ink blot appearance. Cystoid Macular Edema CME Definition and Etiology - CME is a final common pathological response of retina to a variety of insults, consisting of fluid accumulation in outer plexiform Henles layer and inner nuclear layer of the central macula that results in the formation of visible cystic space. - Initially fluid accumulates intracellularly in Muller cells, with subsequent rupture forming microcystic spaces. These coalesce into larger cavities and may progress to lamellar hole formation at the fovea with irreversible impairment of central vision. - CME is commonly aw intraocular inflammations eg pars planitis, vascular incompetence diabetes RVO, vitreoretinal traction, inherited diseases eg RP or dominant CME, medications epinephrine, latanoprost and most commonly following cataract surgeryQ ka Irvine-Gass syndrome. Agiographically evident CME is seen in 60 ECCE, 20 ICCE and 10-20 phacoemulsification cases all uncomplicated. Clinically significant CME with decreased visual acuity, however, is seen only in 0.2-3 patients. - Planned posterior capsulorrhexis during phacoemulsification does not 1t an increase prevalence of CME, whereas those with inadveent rupture of posterior capsule or persistent vitreous traction to anterior segment are at highest risk. Diabetic retinopathy also increases incidence of post cataract CME. - Conditions aw CME include Postoperative Vascular Inflammatory - Cataract surgery - Diabetic retinopathyQ - Eales disease ECCE ICCE - Retinal vein - Behcets PhacoemulsificationQ obstruction RVOQ syndrome - Inadveent posterior - Ocular ischemic - Birdshot capsular rupture syndrome choroidopathy - Penetrating - Coats disease - Pars planitis keratoplasty - Choroidal - Scleritis - Astigmatic corneal neovascularization - Idiopathic incisions - Idiopathic juxta foveal vitritis - Scleral buckling for telangiectasia - CMV retinitis RD - Acute hypeensive - Toxoplamosis - Laser iridotomy retinopathy - Sarcoidosis - Cryotherapy for - Radiation retinopathy retinal breaks - Retinal aerial Fundal Tumors - Pan-retinal photo macroaneurysm - Choroidal coagulation Inherited melanoma - Nd YAG laser - Retinitis pigmentosaQ - Choroidal capsulotomy risk - Gyrate atrophy hemangioma reduced if delayed for _ Autosomal dominant - Retinal capillary 6 months after CME hemangioma cataract surgery Topical Medications Tractional in aphakic - Vitreo macular - Prostaglandin tractional syndromeQ latanoprost - Idiopathic epiretinal - Adrenaline membrane epinephrine - Nicotinic acid Clinical Presentation - There is typically pre-existing cause such as cataract surgery most common or diabetic retinopathy etc. - Blurring and distoion : The major symptom is decreased central visual acuity. Accompanying symptoms include metamorphopsia, micropsia, scotoma, ocular irritation, photophobia and conjunctival injection. 