Medical treatment of cystoid macular edema

Although cystoid macular edema (CME) represents a major cause of visual loss in uveitis, the consensus on its treatment has not yet been reached. We performed a literature review on the efficacy of diverse medical treatment modalities for uveitic CME and suggest novel treatment recommendations. A literature search retrieved 173 citations (MEDLINE, conducted in March 2002, terms: macular edema, uveitis, treatment) and relevant publications were studied. The literature contained information based mainly on case series; the specific treatment targets were not clear. Causal treatment of the underlying ocular condition was considered essential and various approaches of symptomatic treatment were attempted (immunosuppressive and immunomodulatory agents, acetazolamide, octreotide), all with different inclusion criteria and evaluation protocols. The decision to initiate the symptomatic treatment of CME was usually made in cases with already compromised visual acuity. Despite aggressive treatment, the progression of CME with accompanying visual loss was common. On the basis of published results, we recommend starting treatment of CME at an early stage, even in eyes with full visual acuity. Randomized clinical trials are needed to determine the efficacy of diverse treatment modalities and to evaluate the effects of early intervention on inflammatory CME.