Cataract Surgery and Macular Oedema: What You Need to Know

If you’re dealing with cataracts and have also been told you have macular oedema, it’s natural to have questions — and maybe even a few worries — about what this means for your eyesight and your surgery. Both conditions can impact your central vision, but in very different ways. Cataracts cloud the lens of your eye, while macular oedema is caused by swelling in the central retina (the macula), where your sharpest vision comes from. When the two occur together, your eye specialist needs to take extra care in planning your treatment.

In this guide, we’ll go through exactly what macular oedema is, how it interacts with cataract surgery, the ways it can be detected and treated, and how to give yourself the best possible chance of good vision afterwards. By the end, you’ll have a clearer idea of what to expect, and you’ll be in a stronger position to discuss your options with your surgeon.

Understanding Macular Oedema

The macula is the very centre of your retina, responsible for fine detail and central vision. When it swells — a condition known as macular oedema — the normally crisp arrangement of retinal cells becomes disrupted. This swelling is usually caused by fluid leaking from damaged or weakened blood vessels in the retina. That leakage can be the result of many different conditions, such as diabetic retinopathy, retinal vein occlusion, uveitis (inflammation inside the eye), or even after eye surgery itself.

Macular oedema doesn’t just make things look blurry; it can cause distortions, make straight lines look wavy, and reduce your ability to read or recognise faces. The severity can vary — some people only notice mild changes, while others experience significant vision loss. The key point to remember is that macular oedema is a retinal problem, not a lens problem, so even if the cataract is removed, the oedema can still limit the sharpness of your vision.

How Macular Oedema Can Affect Cataract Surgery Outcomes

When you have both a cataract and macular oedema, the surgery may still be worthwhile — but the outcome can be less predictable. This is because cataract surgery can’t fix retinal damage or swelling. In some cases, removing the cataract improves clarity but the central blur from the oedema remains. In others, the clearer view through the lens means your retina responds better to treatment, and vision improves more than expected.

There’s also another important factor: cataract surgery itself can trigger or worsen macular oedema. This is called cystoid macular oedema (CMO), which can develop after surgery due to inflammation. If you already have macular oedema before surgery, your surgeon will want to minimise that risk and manage any existing swelling before going ahead. In most cases, a careful pre-operative plan involving anti-inflammatory drops or retinal injections can help keep the swelling under control.

Causes of Macular Oedema Relevant to Cataract Patients

Not all macular oedema has the same cause, and the underlying reason matters when deciding on surgery timing. Here are some of the more common scenarios:

• Diabetic macular oedema (DMO): Caused by diabetes-related blood vessel leakage, often treated with injections or laser before surgery.
• Post-retinal vein occlusion oedema: Following a blockage in a retinal vein, swelling may persist for months or years.
• Uveitic macular oedema: Associated with eye inflammation; surgery is generally delayed until inflammation is fully controlled.
• Post-surgical CMO: Sometimes occurs after cataract surgery in otherwise healthy eyes, usually temporary but requiring treatment.

If your oedema is caused by a chronic retinal condition, your retina specialist and cataract surgeon will likely work together to coordinate treatment so you go into surgery with the swelling as stable as possible.

Timing Cataract Surgery When You Have Macular Oedema

Deciding when to have cataract surgery in the presence of macular oedema is a balancing act. Leave the cataract too long and your vision may be severely affected — plus, a harder, denser lens can make surgery more difficult. Operate too soon, though, and the retinal swelling might worsen, reducing your final visual result.

The best timing depends on the type of macular oedema, its response to treatment, and how much the cataract is interfering with your daily life. For some, the priority is controlling the swelling first, perhaps with several rounds of injections or steroid implants, before booking surgery. In others — particularly if the cataract is very advanced — the surgeon may recommend proceeding with careful anti-inflammatory protection in place.

How Specialists Detect Macular Oedema Before Cataract Surgery

Detecting macular oedema in someone with a cataract can be tricky — the cloudy lens can block a clear view of the retina. That’s why your eye specialist may use several tools:

• Optical coherence tomography (OCT): This scan gives a detailed cross-section image of your retina, showing even subtle swelling.
• Fluorescein angiography: A dye test to check for leaking blood vessels.
• Clinical examination: Using bright lights and magnifying lenses to look through the cataract.

Sometimes, the cataract is so dense that the retina can’t be fully assessed until after surgery. In such cases, your surgeon will explain the uncertainty and how it could affect your vision.

Pre-Operative Treatments to Protect Your Retina

If you have macular oedema before cataract surgery, your specialist may recommend specific treatments first. These can include:

• Anti-VEGF injections (such as ranibizumab or aflibercept) to reduce leakage in diabetic or vein-occlusion-related oedema.
• Steroid injections or implants for inflammation-driven oedema.
• Topical NSAID and steroid eye drops to calm inflammation.
• Laser treatment in certain diabetic or vein-related cases.

The aim is to bring the swelling down as much as possible before surgery, giving you the best shot at a good result.

Surgical Considerations When You Have Macular Oedema

Cataract surgery in the presence of macular oedema often follows the same basic steps as standard surgery — but with a few important modifications. Your surgeon might:

• Use smaller incisions and gentler techniques to minimise inflammation.
• Administer extra anti-inflammatory medication during or immediately after surgery.
• Coordinate timing with your retina specialist to deliver injections on the same day as surgery.
• Keep post-operative monitoring closer and more frequent.

These steps aim to reduce the risk of post-surgical swelling and protect the retina from further damage.

Post-Operative Care and Recovery

After surgery, you’ll likely be on a combination of anti-inflammatory and steroid drops for longer than someone without retinal disease. Follow-up appointments may be scheduled more often, and you might have repeat OCT scans to check the macula’s response. If swelling worsens after surgery, prompt treatment with injections or stronger steroids can often bring it back under control.

It’s also important to manage any underlying condition — such as controlling blood sugar in diabetes — as this can directly influence how well your retina recovers.

What to Expect from Your Vision

Setting realistic expectations is crucial. Even with perfect cataract surgery, pre-existing macular oedema means your central vision might not be as sharp as someone without retinal disease. You may still need glasses for best vision, and in some cases, visual aids such as magnifiers can help with reading. The main goal is often to achieve clearer, more comfortable sight than before, even if it isn’t flawless.

Preventing Post-Surgical Macular Oedema

While it’s not always possible to prevent post-surgical CMO, certain measures can reduce the risk:

• Using anti-inflammatory drops before and after surgery.
• Treating any retinal swelling in advance.
• Choosing the right timing for surgery.
• Keeping other health conditions under control.

If you’ve had CMO in the past, make sure your surgeon knows — it may influence the choice of medications.

Living with Cataracts and Macular Oedema

Coping with two vision-limiting conditions can be challenging. Good lighting, high-contrast reading material, and enlarging text on screens can help day-to-day. Low-vision specialists can provide tools and training to make the most of your remaining sight. And keeping up with regular check-ups means any changes can be addressed promptly.

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Here’s the improved section:

FAQ: Cataract Surgery and Macular Oedema

1. Can cataract surgery cure macular oedema?
   No, cataract surgery cannot cure macular oedema because the two conditions affect different parts of the eye. Cataracts cloud the lens, which sits at the front of your eye, whereas macular oedema is swelling in the retina at the back of the eye. Even if the cloudy lens is removed and replaced with a clear one, the swelling in the retina will still need its own separate treatment. This is why your ophthalmologist will usually want to address the oedema before or alongside cataract surgery, so your vision can reach its best possible level.
2. Will macular oedema get worse after cataract surgery?
   In some cases, yes — surgery can cause temporary inflammation inside the eye, and this can make macular oedema worse. This type of swelling after surgery is called cystoid macular oedema (CMO). People who already have macular oedema before surgery are at higher risk, so your surgeon will often use preventative measures such as anti-inflammatory drops or injections. Careful planning before the operation can significantly reduce the likelihood of the swelling worsening afterwards.
3. How do I know if I have macular oedema before surgery?
   Your eye specialist can usually detect macular oedema with an OCT (optical coherence tomography) scan, which creates a detailed cross-sectional image of your retina. Sometimes fluorescein angiography is also used, where a dye is injected into a vein to highlight leaking blood vessels in the eye. However, if your cataract is very dense, it may be hard to get a clear view of the retina until after the lens is removed. In those cases, your surgeon will discuss the uncertainty and explain how this could affect your expected outcome.
4. Should I delay cataract surgery if I have macular oedema?
   Often, delaying surgery until the swelling is under control is the safest option. Operating while the oedema is still active can lead to poorer visual outcomes and a higher risk of worsening the problem. The decision depends on how advanced your cataract is, how stable the oedema is, and how urgently you need better vision. Your cataract surgeon and retinal specialist will usually work together to find the best timing for your individual situation.
5. Can I still have good vision after surgery if I have macular oedema?
   It is possible to have a meaningful improvement in vision, but the final result may not be perfect. Removing the cataract can make things clearer, but if the retinal swelling remains, your central vision may still be blurred or distorted. Many patients still notice an improvement in brightness, colour perception, and general clarity, even if fine detail vision does not fully recover. The key is to go into surgery with realistic expectations about the possible outcome.
6. What treatments are used for macular oedema before cataract surgery?
   The treatment will depend on the cause of your oedema. Common options include anti-VEGF injections for swelling linked to diabetes or vein blockages, steroid injections or implants for inflammation-driven cases, and laser treatment for certain diabetic changes. In addition, you may be prescribed anti-inflammatory eye drops in the lead-up to surgery. The aim is to get the macula as stable as possible so you can achieve the best vision after the cataract is removed.
7. How is post-operative macular oedema treated?
   If swelling develops or worsens after surgery, it is usually managed with a combination of anti-inflammatory drops and, if necessary, steroid or anti-VEGF injections. The choice of treatment depends on how severe the oedema is and what caused it in the first place. Prompt intervention is important because untreated swelling can become more difficult to reverse over time. Follow-up scans and check-ups help ensure any post-surgical swelling is spotted and treated early.
8. Is it safe to have both cataract surgery and a retinal injection on the same day?
   In many cases, yes — especially when your cataract surgeon and retinal specialist coordinate the timing. Giving an anti-VEGF or steroid injection at the time of surgery can help protect against post-operative swelling and inflammation. This approach is often used for patients with ongoing retinal disease to give the eye the best chance of healing without further swelling. Your care team will discuss the pros and cons of combining the two procedures.
9. How long will I need to use drops after surgery?
   People with macular oedema often need to use anti-inflammatory and steroid drops for longer than standard cataract patients. Instead of the usual four weeks, you might be advised to continue for several months to keep swelling under control. The exact duration will depend on how your retina responds during follow-up visits. Stopping drops too soon can lead to a flare-up, so it’s important to follow your specialist’s instructions closely.
10. Will I need special follow-up after surgery?
    Yes — patients with macular oedema typically require more frequent follow-up appointments and OCT scans to monitor the macula closely. Early detection of any swelling allows for quick treatment, which can protect your vision. These check-ups also give your specialist a chance to fine-tune your medication schedule and spot any other complications early. Even after the initial healing period, long-term monitoring may be needed if you have an underlying retinal condition.

Final Thoughts

Having both cataracts and macular oedema can feel daunting, but with the right planning and communication between you and your eye care team, it’s possible to achieve meaningful improvements in your vision. The key is understanding that while cataract surgery can clear the cloudy lens, it won’t directly fix swelling in the retina — that needs targeted treatment. By stabilising the oedema first, choosing the right timing for surgery, and following your aftercare plan closely, you give yourself the best chance of an excellent outcome. If you’d like tailored guidance, our team at London Cataract Centre can assess your macula, coordinate care with a retinal specialist, and design a step-by-step plan that fits your goals and daily life.

References

1. Chu, C.J., Johnston, R.L., Buscombe, C., Sallam, A., Mohamed, Q. & Yang, Y.C. (2016) Risk factors and incidence of macular oedema after cataract surgery: a database study of 81,984 eyes. Ophthalmology, 123(2), pp.316–323. Available at: https://pubmed.ncbi.nlm.nih.gov/26681390/ (Accessed 6 August 2025).
2. Wielders, L.H.P., Schouten, J.S.A.G., Winkens, B., van den Biggelaar, F.J.H.M., Veldhuizen, C.A., Murta, J.C., Lobo, C., Simons, R.W. & Nuijts, R.M.M.A. (2018) ESCRS PREMED study report 1: Randomised controlled trial on NSAIDs and corticosteroids for preventing cystoid macular oedema after cataract surgery. Ophthalmology, 125(2), pp.195–204. Available at: https://pubmed.ncbi.nlm.nih.gov/29778106/ (Accessed 6 August 2025).
3. Henderson, B.A., Kim, J.Y., Ament, C.S., Ferrufino-Ponce, Z.K., Grabowska, A. & Cremers, S.L. (2007) Clinical pseudophakic cystoid macular oedema: risk factors for development and duration after treatment. Journal of Cataract & Refractive Surgery, 33(9), pp.1550–1558. Available at: https://pubmed.ncbi.nlm.nih.gov/17720069/ (Accessed 6 August 2025).
4. Munk, M.R., Jampol, L.M., Simader, C., Larsen, M., Arnarsson, A., Singh, R.P., Gillies, M.C. & Loewenstein, A. (2015) Differentiation of diabetic macular oedema from pseudophakic cystoid macular oedema by spectral-domain OCT. Investigative Ophthalmology & Visual Science, 56(11), pp.6724–6733. Available at: https://iovs.arvojournals.org/arvo/content_public/journal/iovs/934564/i1552-5783-56-11-6724.pdf (Accessed 6 August 2025).
5. Lim, B.X., Lim, C.H., Lim, D.K., Evans, J.R., Bunce, C. & Wormald, R. (2016) Prophylactic non-steroidal anti-inflammatory drugs for the prevention of macular oedema after cataract surgery. Cochrane Database of Systematic Reviews, 11, CD006683. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6464900/ (Accessed 6 August 2025).