Controversies in Pharmacological Treatment of Inflammatory Component of Macular Edema

Abstract

Macular edema (ME) is a common, final pathway for many different ocular and systemic diseases. The most common diseases include: diabetic retinopathy (DR), retinal vascular disorders (such as central and branch retinal vein occlusion), and uveitis. The complex and multifactorial pathophysiological mechanisms leading to ME, are still poorly understood. Inflammation plays a crucial role in the genesis of ME, as demontrsated by significant increase of different cytokines and chemokines, (besides vascular endothelial growth factors-VEGF) in ocular fluids. Currently, intravitreal steroids and anti-VEGF drugs are the most used treatments in ME of retinal vascular origin. This review will address the most important (with highest level of scientific evidence and longest followup) results on the use of intravitreal steroids and anti-VEGF drugs, starting from molecular basis to the most updated randomized clinical trials.