We performed a prospective study evaluating the incidence of angiographic cystoid macular edema (CME) following extracapsular cataract extraction and posterior chamber intraocular lens implantation. Of the 162 eyes in the study, 141 were randomized into either a primary capsulotomy or a capsule intact group. The remaining eyes were not randomized due to intraoperative surgical complications, but they were included in the follow-up studies. Six weeks after surgery, angiographic CME was documented in 24% of the capsulotomy group and in 16% of the capsule intact group. The differences were not statistically significant. Including nonrandomized cases reduced the overall incidence of angiographic CME and the difference between the two groups. Angiographic CME was usually not extensive, and it was associated with a visual acuity less than 20/40 in 2.5% of eyes six weeks postoperatively. A subgroup of 120 eyes was followed up for approximately six months, when angiographic CME was present in 4% of the capsulotomy and capsule intact groups.