Cystoid macular oedema in uveitis: An unsolved problem

Abstract

Most papers on the subject of CMO associated with uveitis are retrospective, combine patients with different disease aetiologies, at different stages of evolution, and often describe patients who were previous treatment failures with other therapies besides the one under consideration. There are almost no prospective randomised double-masked controlled studies. This is perhaps in part due to the relative sparsity of uveitis patients seen by many uveitis centres. At the moment, treatment is largely empirical, based in large part on the studies, and others, quoted above. The need to regularly repeat courses of therapy, loss of efficacy of certain form of therapy after repeated use, and cumulative side-effects, all need to be taken into consideration when interpreting results and deciding upon the best approach to be adopted. The risks to the patient's well-being increase with the addition of systemic medication, and long-term steroid use can cause hypertension, induce or exacerbate diabetes, cause premature osteoporosis, cushingoid features, peptic ulceration and aseptic necrosis of the femoral head. Immunosuppressive drugs can be nephrotoxic, hepatotoxic, cause hypertension, gastric disturbances and excessive hair growth. The assessment of macular changes, both structurally and functionally, is the key aspect in understanding visual loss in CMO and also in predicting potential visualrecovery. The combined use of the various tools mentioned here, such as SLO, OCT and electrodiagnostic tests, may give us some of the necessary answers in this process. However, all these tests will need to be validated. A prospective analysis of CMO in cases of uveitis, especially if coupled with therapeutic intervention, will give us the opportunity to achieve this objective.

Risk factors for cystoid macular oedema in patients with uveitis

“…15,16 The prevalence of CMO has further been associated with specific uveitis entities including pars planitis, Behçet's syndrome, birdshot chorioretinopathy, and peripheral multifocal choroiditis. [17][18][19] In this present study, the most important prognosticator for the presence of inflammatory CMO was the advancing age of the patient, which seemed to be independent of the duration of uveitis. A longitudinal prospective study should be performed to see if these factors contributed to the development of CMO.…”

Fundus autofluorescence and spectral domain optical coherence tomography in uveitic macular edema

“…Early detection and treatment could improve the final outcome. Therefore, diagnostic methods with high sensitivity and reliability and valid visual prognosticators are warranted [3][4][5].…”

Analysis of Outer Nuclear and External Limiting Membrane Layers Pattern on Spectral-Domain Optical Coherence Tomography in Patients with Posterior Uveitis with or without Cystoid Macular Edema

“…Inflammatory cell infiltration and protein secretion, retinal cell damage, vitreoretinal traction, and epiretinal membrane formation may all be contributing factors. The blood-retinal barrier may break down as a result of Retinal Pigment Epithelium (RPE) changes, capillary endothelium damage or loss of auto regulatory control of blood flow [9]. Quantitative assessment of macular thickening using OCT is useful in predicting the response to treatment of all types of macular edema.…”