Macular alterations secondary to intraocular inflammatory disease

It is often the sequelae of intraocular inflammation that is most damaging to the patient's vision. Macular alterations are frequently seen and include neovascularization, both subretinal and retinal; pre-retinal membranes, particularly in young patients with recurrent vitreal hemorrhages; macular holes; and cystoid macular edema, by far the most common alteration. The goal in assessing the maculae of these patients is to determine if and what type of therapy might be applicable. In addition to fluorescein angiography, we have found that laser interferometry is a useful tool in predicting the visual outcome of patients with uveitis. Therapeutic modalities center around corticosteroids, while cyclosporine also has been found to be effective in treating cystoid edema. Vitrectomy has been suggested as a therapeutic approach to both the uveitis and cystoid edema, but this approach still needs to be more scientifically evaluated. A well-defined therapeutic approach to uveitis-induced macular changes is lacking, with well-designed clinical trials sorely needed.