the introduction of modern surgical techniques including phacoemulsification and small incision cataract surgery has contributed to a reduction in the incidence of cme since it was initially reported by irvine in 1953 .
angiographic cme is detected by fluorescein angiography and is significantly more common than clinical cme .
clinical and optical coherence tomography ( oct ) evidence of cme after uncomplicated cataract surgery is present in around 0.12.35 and 5% , respectively [ 1 , 4 , 5 ] .
the diagnosis of cme was previously made with fluorescein angiography after the patient became symptomatic ; however , the emergence of oct has provided a quick and noninvasive means of diagnosis .
patient factors predisposing to cme include comorbidities with high vasoactive profile ( diabetic retinopathy , uveitis ) , while surgical factors include inflammation - inducing complications such as retained lens material , vitreous loss and vitreomacular traction .
however , many otherwise healthy patients who undergo routine surgery continue to develop the condition .
the most frequently applied treatment paradigms include aggressive topical nonsteroidal anti - inflammatory drugs or steroids aimed at minimizing inflammation [ 6 , 7 ] . while the condition is usually self - limiting and the resolution of symptoms is likely to occur within 312 months , it may occasionally persist and lead to permanent vision loss .
the prevention of irvine - gass syndrome continues to pose challenges for ophthalmologists , due to its ability to affect individuals without any obvious predisposing factors at variable times of onset postoperatively .
an 82-year - old male with no significant past ocular history was referred for evaluation and treatment of progressive blurred vision secondary to bilateral cataract ( 1 + cortical , 2 + nuclear sclerotic ) by his optometrist .
his best - corrected visual acuity ( bcva ) was 6/9 in both eyes , with no evidence of any other ocular disease .
his past medical history was significant only for hypertension , which was well controlled with oral amiodarone and hydrochlorothiazide .
he underwent routine phacoemulsification surgery in the left eye with implantation of an intraocular lens [ single - piece acrylic toric lens ( sn6at3 ) ; alcon , fort worth , tex .
the patient received preoperative topical diclofenac 0.1% hourly for 4 h and a postoperative weaning regimen of chloramphenicol 0.5% and diclofenac 0.1% eye drops , which were ceased on day 28 .
postoperatively at day 9 , bcva decreased to 6/18 , with minor fluorescein staining of the cornea .
consequently , oct was not performed . at day 22 , bcva was reduced to 6/24 .
ketorolac 0.4% eye drops 6 times per day were commenced , and the patient was referred for medical retina opinion , at which time 0.1% dexamethasone drops 6 times per day was commenced .
1d ) and was successfully weaned off all drops 3 months postoperatively . visual acuity in the left eye
once the patient 's macular edema had resolved in the left eye , and following extra risk counseling , routine cataract surgery was performed in the right eye [ single piece acrylic toric lens ( sn6at4 ) ; alcon ] .
the patient was prophylactically prescribed ketorolac 0.4% eye drops q.i.d . and oral indomethacin 25 mg t.d.s .
both of these therapies were continued postoperatively in addition to chloramphenicol 0.5% and dexamethasone 0.1% eye drops both q.i.d .
unfortunately , at day 32 postoperatively , bcva remained poor at 6/18 in the right eye .
no recurrence of cme was seen in the left eye at this time ( fig .
topical dexamethasone 0.1% and prednisolone acetate 1% drops 6 times daily was used and gradually weaned over 4 months .
2c , d ) . while the patient continued to experience occasional flashes in both eyes , bcva recovered to od 6/6 + 4 and os 6/6 + 1 five months after his second surgery .
improvement in his os bcva vision was noted up to 8 months after his initial operation .
bilateral cases of cme have been reported in association with systemic diseases including crohn 's disease   and infections .
limited cases of bilateral cme after cataract surgery have been reported in the literature [ 10 , 11 ] .
irvine - gass syndrome following uncomplicated cataract surgery on this patient 's first eye is not uncommon .
1b ) , in the presence of symptoms , serves as a valuable reminder that evidence of cme on oct examination may not appear until some weeks after cataract surgery . as such
, the possibility of fresh macular pathology must be considered in the assessment of blur postoperatively , even in the light of recently performed normal oct .
the occurrence of irvine - gass syndrome in this patient 's second eye , despite topical and systemic prophylactic measures , was unexpected .
while it is probable that those who develop cme after their first cataract operation are at increased risk of developing it following surgery on their contralateral eye , there is a paucity of evidence for determining the specific level of risk in these individuals .
several studies have reported significant reductions in the incidence of clinical cme with prophylactic use of topical nonsteroidal anti - inflammatory drops , including ketorolac 0.4% , and nepafenac 0.1% , when used in conjunction with topical steroids or oral indomethacin , as was the case with this man 's second eye [ 12 , 13 , 14 , 15 ]
. perhaps higher prophylactic therapy doses or the addition of preoperative topical indomethacin or steroids could be considered in similar cases .
irvine - gass syndrome remains an important differential diagnosis in the evaluation of blurred vision after cataract surgery . a normal oct scan 1 week after extraction does not preclude further cme , and repeated oct studies may be warranted where unexplained blurred vision persists .
patients who develop cme following their first cataract operation should be counseled about the risks of developing the condition following surgery on the contralateral eye , irrespective of prophylactic measures .
the patient 's right and confidentiality have been well protected in all aspects , and he provided informed consent to publish prior to the authors submitting the article .
 purposeto report a case of acute bilateral irvine - gass syndrome.methodsthis is an observational case report.resultsan 82-year - old man with no significant ocular history developed postsurgical pseudophakic cystoid macular edema ( cme ; irvine - gass syndrome ) on consecutive phacoemulsification cataract surgeries . 
 his initial first - eye ( left ) cme developed 25 days after surgery and was managed with topical preparations of dexamethasone 0.1% and ketorolac 0.4% , in addition to a routine post - cataract surgery drop regime . 
 his left cme resolved completely on optical coherence tomography ( oct ) by day 100 , and he subsequently ( after extensive discussion of cme risks ) underwent cataract surgery on his right eye . 
 he was commenced prophylactically on dexamethasone , ketorolac and oral indomethacin 25 mg t.d.s . immediately after surgery ; however , he later developed cme ( od ) on day 32 postoperatively . within 6 months , he achieved complete resolution of his cme in both eyes . 
 his clinical course was documented with serial oct studies.conclusionirvine-gass syndrome remains an important differential diagnosis in the evaluation of blurred vision after cataract surgery , despite decreasing incidence . 
 those who experience cme following their first cataract operation should be counseled about the risks of developing the condition in the contralateral eye , despite prophylactic measures . 
Introduction
Case Report
Discussion
Conclusion
Statement of Ethics
Disclosure Statement