Clinical Ophthalmology (Sep 2019)
Macular edema associated with non-infectious uveitis: pathophysiology, etiology, prevalence, impact and management challenges
Abstract
Horace Massa,1,* Spyros Y Pipis,2,* Temilade Adewoyin,2 Athanasios Vergados,2 Sudeshna Patra,2 Georgios D Panos2,* 1Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland; 2Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK*These authors contributed equally to this workCorrespondence: Georgios D PanosEye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, Whipps Cross Road, Leytonstone, E11 1NR London, UKTel +44 208 539 5522Email [email protected]: Macular edema (ME) is the most common sight-threatening complication in uveitis. The diagnostic and therapeutic management of the uveitic macular edema (UME) might be challenging due to the complex diagnostic workup and the difficulties physicians face to find the underlying cause, and due to its usually recurrent nature and the fact that it can be refractory to conventional treatment. Some of the mild cases can be treated with topical steroids, which can be combined with non-steroid anti-inflammatory drugs. However, immunomodulators such as methotrexate, tacrolimus, azathioprine, cyclosporine and mycophenolate mofetil together with anti-tumor necrosis factor-α (anti-TNF alpha) monoclonal antibodies such as adalimumab and infliximab, may be required to control the inflammation and the associated ME in refractory cases, or when an underlying disease is present. This review of the literature will focus mostly on the non-infectious UME.Keywords: non-infectious uveitis, macular edema, NSAIDs, anti-TNF alpha, corticosteroids, immunomodulators
