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Review
. 2019 Sep 10:13:1761-1777.
doi: 10.2147/OPTH.S180580. eCollection 2019.

Macular edema associated with non-infectious uveitis: pathophysiology, etiology, prevalence, impact and management challenges

Horace Massa #  1 , Spyros Y Pipis #  2 , Temilade Adewoyin  2 , Athanasios Vergados  2 , Sudeshna Patra  2 , Georgios D Panos #  2
Affiliations
Review

Macular edema associated with non-infectious uveitis: pathophysiology, etiology, prevalence, impact and management challenges

Horace Massa et al. Clin Ophthalmol. .

Abstract

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: NSAIDs; anti-TNF alpha; corticosteroids; immunomodulators; macular edema; non-infectious uveitis.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Macular edema secondary to intermediate uveitis in a 58-year-old male patient (left eye). (A) OCT. (B) FFA – typical petaloid pattern. Abbreviations: OCT ,optical coherence tomography ; FFA, fundus fluorescein angiography.
Figure 2
Figure 2
Macular edema secondary to UGH syndrome in a 60-year-old male patient (right eye). Abbreviation: UGH, uveitis-glaucoma-hyphema.
Figure 3
Figure 3
Treatment algorithm for non-infectious uveitic macular edema. Abbreviations: UME, uveitic macular edema; AZA, azathioprine; MTX, methotrexate; MMF, mycophenolate mofetil; IFN, interferon-alpha; PPV, pars plana vitrectomy.
See this image and copyright information in PMC

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