ME represent a major cause of visual loss in uveitis and adequate management is Uveitic macular edema (ME) is a complex condition. There is a strong relationship between the degree of the intraocular inflammation and. When macular edema has become refractory after multiple interventions, pars plana vitrectomy could be considered. Keywords: uveitic macular edema, uveitis. Uveitis and Macular Edema: A Complex Relationship. Chronic uveitis has usually been treated by topical or systemic application of steroids. Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography . Uveitis and Macular Edema: A Complex Relationship.
Treatment of chronic macular edema with acetazolamide. Cystoid macular edema with Docetaxel chemotherapy and the fluid retention syndrome. Acetazolamide for treatment of chronic macular edema in retinitis pigmentosa. Intravitreal bevacizumab Avastin treatment of macular edema in central retinal vein occlusion: Intraocular bevacizumab for macular edema due to CRVO. Intravitreal bevacizumab for pseudophakic cystoid macular edema: J Ophthalmic Vis Res. OCT in the management of diabetic macular edema.
Plasmin-assisted vitrectomy eliminates cortical vitreous remnants. Intravitreal injection of autologous plasmin enzyme for macular edema associated with branch retinal vein occlusion. Intravitreal plasmin without vitrectomy for macular edema secondary to branch retinal vein occlusion. Use of autologous plasmin during vitrectomy for diabetic maculopathy.
Interventions for the treatment of uveitic macular edema: a systematic | OPTH
Microplasmin intravitreal administration in patients with vitreomacular traction scheduled for vitrectomy: Intravitreal injection of microplasmin for treatment of vitreomacular adhesion: A placebo-controlled trial of microplasmin intravitreous injection to facilitate posterior vitreous detachment before vitrectomy.
A single injection of microplasmic for the treatment of symptomatic vitreomacular adhesion sVMA: Invest Ophthalmol Vis Sci suppl. Vitrectomy for chronic aphakic cystoid macular edema. Results of a national, collaborative, prospective, randomized investigation. Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction.
Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid. Pars plana vitrectomy for chronic pseudophakic cystoid macular edema.
Vitrectomy for persistent diffuse diabetic macular edema. Vitrectomy results for diffuse diabetic macular edema with and without inner limiting membrane removal. Visual acuity comparison of vitrectomy with and without internal limiting membrane removal in the treatment of diabetic macular edema. Pars plana vitrectomy with and without peeling of the inner limiting membrane for diabetic macular edema.
Comparative evaluation of vitrectomy and dye-enhanced ILM peel with grid laser in diffuse diabetic macular edema.
Taut internal limiting membrane causing diffuse diabetic macular edema after vitrectomy: Pars plana vitrectomy for diabetic macular edema.
Internal limiting membrane delamination vs posterior hyaloid removal. A prospective randomized trial. Pars plana vitrectomy, internal limiting membrane peeling, and panretinal endophotocoagulation for macular edema secondary to central retinal vein occlusion. Surgical intervention in refractory CME — role of posterior hyaloid separation and internal limiting membrane peeling. Pars plana vitrectomy with intravitreal triamcinolone: Vitreoretinal surgery for cystoid macular edema associated with retinitis pigmentosa.
Macular abnormalities in patients with retinitis pigmentosa: Pigment epithelium-derived factor and vascular endothelial growth factor in branch retinal vein occlusion with macular edema.
Role of soluble vascular endothelial growth factor receptor-1 in the vitreous in proliferative diabetic retinopathy. Visual acuity and foveal thickness after vitrectomy for macular edema.
Interventions for the treatment of uveitic macular edema: a systematic review and meta-analysis
Changes in foveal thickness after vitrectomy for macular edema with branch retinal vein occlusion and intravitreal vascular endothelial growth factor. Vitrectomy prevents retinal hypoxia in branch retinal vein occlusion. Vitrectomy surgery increases oxygen exposure to the lens: Oxygen distribution in the human eye: A gauge cannula is inserted and advanced 3 mm within the episcleral space. The cannula is advanced about 12—14 mm in the sub-Tenon space with the stylet withdrawn.
The syringe is then loaded with the steroid and injected.
It has been used to treat macular edema from a variety of other etiologies, including retinal vein occlusion, diabetic retinopathy, pseudophakic CME, and exudative macular degeneration. It is injected into the vitreous using an injector. Dexamethasone is then released over 3—6 months. It can be inserted in the clinic, in contrast to nonbiodegradable implants, which require a surgical procedure in the operating theater.
It is licensed in the US for posterior uveitis. The implant itself is a 1. The implant is surgically placed into the vitreous cavity. Pharmacokinetic studies in rabbits have demonstrated the delivery of constant levels of the corticosteroid to the posterior pole. Although there is a reduction in systemic side effects, there are significant local side effects, including increased intraocular pressure requiring filtration surgery and cataract progression.
Carbonic anhydrase catalyzes the hydration of carbon dioxide to bicarbonate, which dissociates to form hydrogen ions and bicarbonate. One subtype of carbonic anhydrase is isoenzyme IV, which is thought to be a membrane-bound fraction found in the apical region of the RPE cell. Inhibition of carbonic anhydrase reduces aqueous production and possibly fluid leaking from the RPE.
It is a potent inhibitor of the release of growth hormone and other hormones. It is most commonly used for the treatment of acromegaly, carcinoid tumors, and vasoactive intestinal polypeptide-secreting tumors. Given the receptors are housed in the RPE, somatostatin may play a role in fluid and ion-transport balance.
Somatostatin may also inhibit the immune response and have a role in controlling inflammation. Hence, octreotide has been hypothesized as a potential treatment for uveitic macular edema. Aptamers are oligonucleotide ligands that are selected for high-affinity binding to molecular targets. VEGF has been shown to be an endothelial cell-specific mitogen, an angiogenic inducer, and is also known to increase retinal vessel permeability. This cross-sectional study measured VEGF concentrations by enzyme-linked immunosorbent assays in the aqueous humor in uveitic and healthy patients.
Thus anti-VEGF may be useful in the treatment of uveitic macular edema. These showed low incidence rates of 0. Adalimumab is a fully human antibody. Infliximab is a chimeric antibody, ie, it has a murine component.
ICAM may play a role in the regulation of vascular permeability through the leukocyte—endothelium interaction.
Cystoid Macular Edema - EyeWiki
Efalizumab is an inhibitor of ICAM that inhibits binding of lymphocyte function-associated antigen. Best-corrected visual acuity and central macular thickness were the primary outcome measures. Secondary outcome data including adverse effects were collected. More results from randomized controlled trials with long follow-up periods are needed for interventions for uveitic macular edema to assist in determining the overall long-term benefit of different treatments.
The only intervention with sufficiently robust randomized controlled trials for a meta-analysis was acetazolamide, which was shown to be ineffective in improving vision in eyes with uveitic macular edema, and is clinically now rarely used. Interventions showing promise in this disease include dexamethasone implants, immunomodulatory drugs and anti-vascular endothelial growth-factor agents.
When macular edema has become refractory after multiple interventions, pars plana vitrectomy could be considered. The disease pathophysiology is uncertain and the course of disease unpredictable.