Cystoid Macular Edema in Uveitis

Abstract

Macular edema is a major cause of morbidity in uveitis patients. Inflammatory mediators act on the integrity of the blood ocular barrier and on the function of the RPE pump. Chronicity leads to irreversible changes and is reported to cause up to 30% of permanent visual loss in uveitis patients. Assessing the presence and severity of edema with appropriate investigational techniques (Spectral domain OCT, and angiography) help to determine its reversibility and define a therapeutic strategy wherein intraocular steroids play a key role while RPE pump stimulators and surgery are restricted to more severe disease or the presence of tractional syndromes.

Differential Diagnosis of Macular Edema of Different Pathophysiologic Origins by Spectral Domain Optical Coherence Tomography

“…1 Macular edema can be seen in association with many ocular diseases and is a final common pathway of many multifactorial disease processes. 1,2,[4][5][6][7] In inflammatory MEs such as uveitis and Irvine-Gass, ME is predominantly based on a release of proinflammatory mediators. Decreased pigment epithelium pump function also may lead to the accumulation of fluid.…”

“…2,3 A major pathway of ME development is a breakdown of the inner and/or outer blood-retina barriers with increased vascular permeability. 5,8 In retinal vein occlusion (RVO), cytokine release, hypoxia, increased hydrostatic pressure, and vascular stasis may contribute to ME formation. 1,2,[4][5][6][7] In inflammatory MEs such as uveitis and Irvine-Gass, ME is predominantly based on a release of proinflammatory mediators.…”

The Relationship of Central Foveal Thickness to Urinary Iodine Concentration in Retinitis Pigmentosa With or Without Cystoid Macular Edema

“…42 So, perhaps higher physiological levels of iodine could promote RPE integrity in RP patients with intraretinal cysts. Iodine might serve a similar role also in patients with CME secondary to uveitis, who are thought to have lost integrity of the outer blood-retina barrier and RPE pump, 43 or in patients with CME secondary to diabetic retinopathy, given that dysfunction of the outer blood-retina barrier has been observed in diabetic patients. 44-47 …”

Fibrinolysis in normal vitreous liquid

“…All participants underwent standard 23-gauge three-port pars plana vitrectomy for macular surgery (macular hole closure, macular pucker removal) or vitreous floater elimination. Exclusion criteria included the presence of vitreoretinal diseases with a BRB disturbance, including diabetic macular oedema [6], exudative macular degeneration [7], macular oedema due to retinal vein occlusion [8] or uveitis [9] and vitreomacular traction (VMT) syndrome [10], furthermore previous intravitreal drug injections, laser photocoagulation, previous vitrectomy or other intraocular surgery including cataract surgery within the last 6 months, signs of glaucoma in the study eye, participation in any clinical trial, use of immunosuppressive drugs or history of malignant tumours of any location.…”