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World J Ophthalmol. Aug 12, 2014; 4(3): 56-62
Published online Aug 12, 2014. doi: 10.5318/wjo.v4.i3.56
Updates in uveitic macular edema
Samir S Shoughy, Igor Kozak
Samir S Shoughy, The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh 11462, Saudi Arabia
Igor Kozak, Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia
Author contributions: Shoughy SS and Kozak I solely contributed to this paper.
Correspondence to: Igor Kozak, MD, PhD, Senior Academic Consultant, Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh 11462, Saudi Arabia.
Telephone: +966-14821234-3772 Fax: +966-14821234-3727
Received: April 25, 2014
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

Keywords: Intraocular inflammation, Uveitic macular edema, Fluorescein angiography, Optical coherence tomography, Corticosteroid therapy, Drug delivery, Clinical trials

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.