Pseudophakic macular edema and oral acetazolamide: an optical coherence tomography measurable, dose-related response.

PURPOSE Although uncommon after phacoemulsification surgery, cystoid macular edema (CME) is an important cause of postoperative reduction of vision after cataract surgery. To demonstrate an optical coherence tomography (OCT) measurable, dose-related response to orally administered acetazolamide in a patient presenting with pseudophakic CME. METHODS A 76-year-old woman with reduced vision in right eye due to cataract had uneventful phacoemulsification. Surgery was complicated by early onset endophthalmitis that was treated with intravitreal antibiotics with good visual recovery. At 6 months follow-up, she presented with further reduction of vision (0.5 LogMAR) due to CME and a central foveal thickness (CFT) of 587 microm. RESULTS Acetazolamide treatment was started in combination with topical ketorolac. At a daily dose of 500 mg, CFT and visual acuity were 262 microm and 0.34 LogMAR, respectively. Dose reduction of acetazolamide to 250 mg/day was associated with worsening of the CFT to 335 microm. CFT was subsequently measured at 230 microm on increasing the acetazolamide dose to 500 mg/day and measured 353 microm when acetazolamide dose was halved. CFT was 478 microm when acetazolamide was ceased.CONCLUSIONS. In this report, the authors have shown a dose-related response of pseudophakic CME to oral acetazolamide. This would suggest that the clinical response to oral acetazolamide may be titrated to the extent of CME and monitored by OCT.