Recent progress in the treatment of uveitic macular edema

ABSTRACT

Introduction: Macular edema (ME) is defined as a thickening of the macular area, which results from a breakdown of the outer and/or inner blood-retina barrier. It is usually accompanied by quantity and quality loss of central vision. Uveitic macular edema (UME) is a leading cause of visual loss due to macular edema chronification. A number of treatment options are available for UME including periocular and intravitreal corticosteroids, immunosuppressants and biological agents. Pars plana vitrectomy also plays a role in refractory patients.

Areas covered: We herein provide a summary of current options to treat UME, highlighting strengths and weaknesses on the basis of available literature and self-experience.

Expert opinion: Visual prognosis in uveitis has improved as treatment of macular edema has done in the last decade. Corticosteroid slow-release intravitreal implants as well as anti-TNF and anti-IL-6 biologic drugs have been the cornerstone of these medical advances.

KEYWORDS:

• Uveitic macular edema
• non-infectious uveitis
• dexamethasone intravitreal implant
• fluocinolone acetonide intravitreal implant
• anti-tumor necrosis factor alpha
• anti-interleukin 6
• pars plana vitrectomy
• corticosteroids

Article highlights

• Uveitic macular edema (UME) is a common complication in patients with uveitis.

• The treatment of UME has not a consensus, being a challenge to choose the correct treatment for each patient.

• New local therapy as sustained-release corticosteroid seems to be effective for the resolution of UME, mainly in unilateral cases.

• Long-term release implant as fluocinolone acetonide intravitreal implant may be an option to diminish the reinjections of other intravitreal agents.

• Biologic therapies are effective in UME with a good safety profile.

Adalimumab is the only one biologic drug approved for noninfectious uveitis and its consequent UME treatment.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.