Update on the Management of Uveitic Macular Edema

Abstract

Uveitic macular edema (ME) is a frequent complication in 8.3% of uveitis patients and is a leading cause of serious visual impairment in about 40% of cases. Despite the numerous available drugs for its treatment, at least a third of patients fail to achieve satisfactory improvement in visual acuity. First-line drugs are steroids administered by various routes, but drug intolerance or ineffectiveness occur frequently, requiring the addition of other groups of therapeutic drugs. Immunomodulatory and biological drugs can have positive effects on inflammation and often on the accompanying ME, but most uveitic randomized clinical trials to date have not aimed to reduce ME; hence, there is no clear scientific evidence of their effectiveness in this regard. Before starting therapy to reduce general or local immunity, infectious causes of inflammation should be ruled out. This paper discusses local and systemic drugs, including steroids, biological drugs, immunomodulators, VEGF inhibitors, and anti-infection medication.

Suprachoroidal Space Triamcinolone Acetonide: A Review in Uveitic Macular Edema

“…Due to its complex etiology and interpatient variability, management of uveitic macular edema may involve multiple drug classes targeting different pathological features of the disease, and the regimen of choice depends on the needs of the patient, often with a focus on patient safety [ 23 ]. Corticosteroids, administered through various routes, remain the mainstay of treatment for most cases of acute uveitis [ 23 ].…”

“…Due to its complex etiology and interpatient variability, management of uveitic macular edema may involve multiple drug classes targeting different pathological features of the disease, and the regimen of choice depends on the needs of the patient, often with a focus on patient safety [ 23 ]. Corticosteroids, administered through various routes, remain the mainstay of treatment for most cases of acute uveitis [ 23 ]. The current ophthalmic corticosteroids approved in the USA include fluocinolone acetonide intravitreal implants (Iluvien ® [ 24 ], Yutiq ® [ 25 ], Retisert ® [ 26 ]), dexamethasone intravitreal implant (Ozurdex ® [ 27 ]), and triamcinolone acetonide intravitreal injection (Triesence ® [ 28 ]).…”

To Determine the Efficacy of Suprachoroidal Triamcinolone Injection for the Treatment of Refractory Diabetic Macular Edema

“…In recent years, the efficacy of IVTA in the treatment of DME has become thoroughly established. However, numerous investigations have demonstrated the high incidence of cataract development and gradually raises intraocular pressure 17 . This is particularly factual when chronic DME is controlled by a series of repeated injections.…”

Efficacy and safety of single-dose intravitreal dexamethasone implant in non-infectious uveitic macular edema: A systematic review and meta-analysis

“…Local and systemic uses of corticosteroids are the first-line treatment option for UME, while long-term use may be burdened by multiple side effects, including poor blood glucose control, osteoporosis, cataract progression, and ocular hypertension (6). Therefore, different interventions including immunomodulatory agents, anti-VEGF, and pars plana vitrectomy are also adopted for UME (7). However, the prognosis remains unsatisfactory in patients with chronic and refractory UME.…”