A 70-year-old man presents with deterioration of vision 3 weeks after cataract extractionand IOL implantation. Slit lamp examination shows honeycomb maculopathy and Fluorescinangiography {FA} shows ‘flower petal’ hyperfluorescence. The most likely diagnosis is –

Okay, let's tackle this question. The patient is a 70-year-old man with vision deterioration three weeks after cataract surgery and IOL implantation. The key findings are honeycomb maculopathy and 'flower petal' hyperfluorescence on FA.

First, I need to recall the possible postoperative complications of cataract surgery. Common issues include endophthalmitis, cystoid macular edema (CME), posterior capsule opacification, and retinal detachment. But the time frame here is three weeks, which is a bit late for acute endophthalmitis, which usually presents within days.

Honeycomb maculopathy and flower petal hyperfluorescence sound familiar. CME is a classic cause of postoperative vision loss. CME occurs due to fluid accumulation in the macula, leading to a cystoid appearance. FA shows early hypofluorescence and late staining, but the 'flower petal' pattern is specific for CME. The honeycomb appearance under slit lamp might be due to the edema causing a mosaic-like pattern.

Now, checking the options. The correct answer is likely Cystoid Macular Edema (CME). Let's think about other options. Posterior capsule opacification would present with a hazy capsule, not macular changes. Retinal detachment would have different FA findings, like filling defects. Uveitis could cause macular edema, but the 'flower petal' is more specific for CME.

Wait, the question mentions honeycomb maculopathy. That's a classic sign of CME. FA's flower petal hyperfluorescence is also a hallmark. So the answer is CME. The other options don't fit the imaging findings. The clinical pearl here is that late postoperative vision loss with these findings points to CME. Treatment is usually topical NSAIDs or steroids.

**Core Concept**
This question assesses the recognition of **postoperative cystoid macular edema (CME)** after cataract surgery, focusing on its characteristic clinical and angiographic findings. CME results from disruption of the blood-retinal barrier, leading to fluid accumulation in the macula.

**Why the Correct Answer is Right**
CME is a common complication of cataract surgery, typically presenting 1–4 weeks postoperatively. The **honeycomb maculopathy** on slit lamp (due to intraretinal cystic spaces) and **"flower petal" hyperfluorescence** on fluorescein angiography (from late staining of edematous retinal pigment epithelium) are hallmark signs. It is mediated by inflammatory cytokines (e.g., VEGF) and often treated with NSAIDs or corticosteroids.

**Why Each Wrong Option is Incorrect**
**Option A:** Posterior capsule opacification causes visual blurring but no macular edema or FA abnormalities.
**Option B:** Endophthalmitis presents acutely (<7 days) with severe pain, hypopyon, and diffuse vitritis, not "flower petal" patterns. **Option D:** Retinal detachment shows FA leakage at breaks and subretinal fluid, not macular cystoid changes. **Clinical Pearl / High-Yield Fact** Remember **"CME = flower petal + honeycomb"** on FA and

✓ Correct Answer: D. Cystoid Macular Edema