Published online Aug 12, 2014. doi: 10.5318/wjo.v4.i3.56
Revised: May 21, 2014
Accepted: July 12, 2014
Published online: August 12, 2014
Macular edema is one of the most common vision-threatening complications of uveitis noted in one third of patients with uveitis. The release of a number of inflammatory mediators induces retinal vascular hyperpermeability leading to uveitic macular edema (UME) which most commonly is of cystoid shape. Fluorescein angiography and non-invasive spectral-domain optical coherence tomography are standard procedures for diagnosis and follow-up of UME with some innovations such as scanning laser ophthalmoscope retro-mode imaging. Effective management of UME requires thorough understanding of the individual case. Proper control of intraocular inflammation is mandatory before targeting macular edema itself. Mainstay of treatment is immunosuppressive therapy with various drug delivery routes including topical, local subconjunctival, peribulbar and sub-Tenon’s, intravitreal and systemic. Clinical trials with biologics are under way to study the efficacy of these agents in suppressing intraocular inflammation and resolution of UME. Visual prognosis in UME depends on numerous factors. Younger age and better visual acuity at baseline are associated with more favorable visual outcome in most studies
Core tip: Cystoid macular edema is among leading causes of visual loss in patients with uveitis. Inflammatory cytokines such as interferon-gamma, interleukin-2, interleukin-10, tumor necrosis factor-alpha and prostaglandins are powerful inflammatory mediators which along with the vascular endothelial growth factor are potent mediators of increased vascular permeability in uveitic macular edema. Scanning laser ophthalmoscope in retro-mode is a novel imaging modality that can show each cystoid space located in any layer of the retina and allows the detection of the extent of cystoid macular edema.