Synopsis
Recognise macular fluid as a consequence of several disorders, use symptoms and OCT to assess its significance, and select a cause-specific pathway with appropriate treatment and monitoring.
- Macular oedema is a finding with a cause, not a single interchangeable treatment indication.
- Assess both central visual function and the distribution of fluid on OCT.
- Diabetes, retinal vein occlusion, postoperative inflammation and uveitis are important causes.
Key red flags
Painful visual deterioration after ocular surgery or an injection needs urgent assessment for endophthalmitis or another complication.
Investigation priorities
Characterise central visual loss and the location of retinal fluid.
Management branches
OCT confirms diabetic macular oedema and the retinal team has assessed visual function.
- Offer macular laser for non-centre-involving clinically significant oedema, while addressing systemic risk factors alongside retinal care.
- For centre-involving oedema with good vision, defined by NICE as at least 79 ETDRS letters, consider macular laser or observation.
Key medicines
Prednisolone acetate 1% eye drops, postoperative oedema exampleAn ophthalmologist may prescribe one drop into the affected eye four times daily as the potent steroid component of the RCOphth eight-to-twelve-week postoperative oedema regimen, then adjust or taper according to response.
Ketorolac 0.5% eye drops, AcularFor established postoperative macular oedema, the RCOphth pathway supports ketorolac 0.5%, one drop into the affected eye three or four times daily, alongside a potent steroid for eight to twelve weeks from diagnosis under specialist supervision. This prolonged treatment is off label. The Acular licensed postoperative-inflammation course is one drop three times daily from 24 hours before surgery for up to three weeks afterwards.