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Surgical Management of Macular Edema Associated with Uveitis

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Cystoid Macular Edema

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Abstract

Uveitis is a significant cause of vision loss in the working-age population in the developed world. The most common cause of vision loss in uveitis patients is macular edema (ME). In some cases, maximum-tolerated medical therapy may be inadequate, and compliance with medical regimens may also be an issue. Surgical approaches may provide an alternative or adjunctive means of controlling uveitis and uveitic ME.

Primary vitrectomy for uveitis has been described to remove vitreous haze, potentially to improve control of inflammation, and to assist in diagnosis. Vitreous haze may limit vision as well as limit the ability of the treating ophthalmologist to adequately examine, diagnose, and treat posterior uveitis. Vitrectomy also removes inflammatory modulators contained within the vitreous while prospectively reducing the time inflammatory factors are retained within the vitreous cavity. If the underlying cause of uveitis is in question, a diagnostic vitrectomy may also have the secondary effect of decreasing macular edema.

Uveitic ME is often associated with additional structural complications affecting the posterior segment. Vitrectomy may be indicated for epiretinal membrane, vitreomacular traction, traction or rhegmatogenous retinal detachment, and vitreous hemorrhage. The vitrectomy itself as well as correction of the structural complications may have a beneficial effect on macular edema.

A surgical approach proven effective in randomized, prospective studies is the fluocinolone acetonide intravitreal implant. This sustained-release steroid implant provides an FDA-approved treatment with dramatic effect on uveitic ME.

In this chapter, we review the background, techniques, outcomes, and complications of primary vitrectomy, vitrectomy for structural complications, and fluocinolone implant for uveitis with associated ME.

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  1. Department of Ophthalmology, Rush University Medical Center, 1725 W. Harrison Street, Ste 915, Chicago, IL, 60612, USA

    Alexander L. Grigalunas MD & Pauline T. Merrill MD

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  1. Alexander L. Grigalunas MD
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  2. Pauline T. Merrill MD
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Correspondence to Pauline T. Merrill MD .

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  1. Professor and Chair Department of Ophthalmology and Visual Sciences, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA

    Shlomit Schaal

  2. Evans Professor and Chair of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, USA

    Henry J. Kaplan

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Grigalunas, A.L., Merrill, P.T. (2017). Surgical Management of Macular Edema Associated with Uveitis. In: Schaal, S., Kaplan, H. (eds) Cystoid Macular Edema. Springer, Cham. https://doi.org/10.1007/978-3-319-39766-5_9

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