Evaluation of Management Pathways for Pseudophakic Cystoid Macular Edema in a Large United States Cohort

Purpose: To identify the common management pathways in the treatment of pseudophakic cystoid macular edema (CME). Methods: A retrospective cohort study was conducted from 2005 to 2024 using the TriNetX United States Collaborative Network. Patients diagnosed with pseudophakic CME were included in the study, and patients with retinal comorbidities were excluded. Treatments initiated after the diagnosis of pseudophakic CME, including topical corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), periocular and intravitreal (IVT) corticosteroids, antivascular endothelial growth factor (anti-VEGF) injections, suprachoroidal corticosteroids, and pars plana vitrectomy (PPV), were tracked, and treatment sequences and imaging use over time were analyzed. Results: A total of 23 035 patients met the inclusion criteria, with a mean age of 72 years; 54% were women, and 68% identified as White. The incidence of pseudophakic CME increased from 2.45% in 2005 to 17.6% in 2024. Optical coherence tomography (OCT) use increased over time, becoming the most common imaging modality (used in 90% of cases), while 20% of patients underwent no imaging. No treatment was documented in 40% of patients. Among those treated, 77% received topical corticosteroids and/ or NSAIDs as first-line therapy, followed by IVT steroids (7.4%), periocular steroids (6.5%), PPV (3.4%), and anti-VEGF injections (2%). IVT steroids were the most common second-line treatment (10.2%), primarily dexamethasone implants (82.8%), followed by triamcinolone (12.2%). Use of newer agents, including fluocinolone acetonide implants and suprachoroidal triamcinolone, was uncommon. Conclusions: Despite the increased use of OCT and earlier detection of subclinical cases, a substantial proportion of patients with pseudophakic CME have no documented treatment. Topical steroids and/ or NSAIDs represent the most common first- line therapy, with IVT steroids commonly used after inadequate response to treatment.