<p>Update in treatment of uveitic macular edema</p>

Abstract

Macular edema (ME) represents the most common cause for visual loss among uveitis patients. The management of uveitic macular edema (UME) may be challenging, due to its often recalcitrant nature. Corticosteroids remain the mainstay of treatment, through their capability of effectively controlling inflammation and the associated ME. Topical steroids may be effective in milder cases of UME, particularly in edema associated with anterior uveitis. Posterior sub-Tenon and orbital floor steroids, as well as intravitreal steroids often induce rapid regression of UME, although this may be followed by recurrence of the pathology. Intra-vitreal corticosteroid implants provide sustained release of steroids facilitating regression of ME with less frequent injections. Topical nonsteroidal anti-inflammatory drugs may provide a safe alternative or adjuvant therapy to topical steroids in mild UME, predominantly in cases with underlying anterior uveitis. Immunomodulators including methotrexate, mycophenolate mofetil, tacrolimus, azathioprine, and cyclosporine, as well as biologic agents, notably the anti-tumor necrosis factor-α monoclonal antibodies adalimumab and infliximab, may accomplish the control of inflammation and associated ME in refractory cases, or enable the tapering of steroids. Newer biotherapies have demonstrated promising outcomes and may be considered in persisting cases of UME.

Visual And Anatomical Outcomes of Pars Plana Vitrectomy in Refractory Diabetic Macular Edema

“…In refractory DME cases, the part of vitrectomy without taking into consideration the tractional component is more disputable. Though studies have indicated that peeling of ILM could facilitate getting better results, others studies have depicted similar results by vitrectomy 15 .…”

Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature

“…To date, published reviews, articles and collected literature data about the approved use of Dex implant confirm its efficacy [4][5][6]. Nevertheless, in recent years several additional studies further confirmed the potential benefits of intravitreal Dex for various ocular pathologies with inflammatory etiopathogenesis and ME ( Figure 1).…”

“…The treatment of NIUs and associated ME is still very challenging. Since inflammation is the main pathogenic event in these disorders, corticosteroids, either systemic or regional, represent the mainstay of treatment [5]. Although effective, the use of systemic corticosteroids is limited due to numerous adverse effects [41].…”

Makulaödem bei Uveitis: Pathogenese, Diagnostik und Therapie

“…In einer Studie von Leder et al führte eine einmalige periokuläre Injektion von 20-40 mg Triamcinolon-Acetonid nach 1 Monat bei 53 % der Augen zu einer Rückbildung des Makulaödems [24]. Allerdings kommt es nach periokulärer Kortikosteroidgabe häufig zu Rezidiven mit der Notwendigkeit regelmäßiger Re-Injektionen [25].…”