Inflammatory Macular Edema can cause vision loss when patients with uveitis develop swelling in the center of the retina (which is called macular edema). Uveitis can cause a breakdown of the blood retinal barrier and make the retinal vessels leak. The inflammatory response can disrupt the blood-retinal barrier, leading to increased permeability and fluid leakage into the macula, causing swelling and vision impairment.
The most common form of inflammatory macular edema is pseudophakic (or post-cataract surgery) macular edema. Pseudophakic Cystoid Macular Edema (CME) is a condition that can occur following cataract surgery, where an intraocular lens (IOL) is implanted to replace the natural lens of the eye. CME is characterized by the accumulation of fluid in the macula, the central part of the retina responsible for sharp, detailed vision. In pseudophakic CME, this swelling is unrelated to any pre-existing retinal conditions and is a complication arising from the surgery itself. The exact cause is not fully understood, but it is believed to be associated with inflammatory responses triggered by the surgical process.
Some forms of uveitis, like acute anterior uveitis, intermediate uveitis, and birdshot chorioretinitis commonly cause macular edema which can cause vision loss.
After cataract surgery, about two percent of patients develop macular edema which can cause vision loss. The prevalence may be influenced by factors such as the patient’s age, pre-existing ocular conditions, and the surgical technique employed. Advancements in surgical procedures and the use of anti-inflammatory medications have reduced the prevalence of macular edema.
Several treatment options are available for managing inflammatory and pseudophakic macular edema. It is helpful to balance the risk and benefits of different treatments. Because they are save, generally patients are initially treated with topical anti-inflammatory medications and then the treatment is escalated depending on the patients response.
a. Topical Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in eye drop form may be prescribed to reduce inflammation and control macular edema.
b. Steroid Injections: In some cases, the injection of steroids either next to the eye or into the eye can be considered if a patient does not respond to topical therapy or if the macular edema is very severe.
c. Oral Medications: Systemic medications, such as carbonic anhydrase inhibitors or oral corticosteroids, may be recommended in certain situations to control inflammation and fluid accumulation.
d. Surgical Intervention: In rare and severe cases, surgical procedures like vitrectomy may be considered to remove the vitreous gel and address the underlying causes of CME.
