{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T08:22:19Z","timestamp":1787818939823,"version":"build-2784847793"},"reference-count":62,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T00:00:00Z","timestamp":1631577600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Uveitic macular edema (ME) is a frequent complication in 8.3% of uveitis patients and is a leading cause of serious visual impairment in about 40% of cases. Despite the numerous available drugs for its treatment, at least a third of patients fail to achieve satisfactory improvement in visual acuity. First-line drugs are steroids administered by various routes, but drug intolerance or ineffectiveness occur frequently, requiring the addition of other groups of therapeutic drugs. Immunomodulatory and biological drugs can have positive effects on inflammation and often on the accompanying ME, but most uveitic randomized clinical trials to date have not aimed to reduce ME; hence, there is no clear scientific evidence of their effectiveness in this regard. Before starting therapy to reduce general or local immunity, infectious causes of inflammation should be ruled out. This paper discusses local and systemic drugs, including steroids, biological drugs, immunomodulators, VEGF inhibitors, and anti-infection medication.<\/jats:p>","DOI":"10.3390\/jcm10184133","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T21:47:21Z","timestamp":1631656041000},"page":"4133","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Update on the Management of Uveitic Macular Edema"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0935-8880","authenticated-orcid":false,"given":"Slawomir Jan","family":"Teper","sequence":"first","affiliation":[{"name":"Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1001\/jamaophthalmol.2013.4237","article-title":"Incidence and prevalence of uveitis: Results from the Pacific Ocular Inflammation Study","volume":"131","author":"Acharya","year":"2013","journal-title":"JAMA Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"253","DOI":"10.4103\/0301-4738.114090","article-title":"Uveitis in developing countries","volume":"61","author":"Rao","year":"2013","journal-title":"Indian J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1016\/j.ophtha.2006.03.027","article-title":"Impact of macular edema on visual acuity in uveitis","volume":"113","author":"Lardenoye","year":"2006","journal-title":"Ophthalmology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.2147\/OPTH.S180580","article-title":"Macular edema associated with non-infectious uveitis: Pathophysiology, etiology, prevalence, impact and management challenges","volume":"13","author":"Massa","year":"2019","journal-title":"Clin. Ophthalmol."},{"key":"ref_5","first-page":"e524","article-title":"Cat-scratch disease: Ocular manifestations and treatment outcome","volume":"96","author":"Trivizki","year":"2018","journal-title":"Acta Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1177\/1120672119856943","article-title":"Lyme-associated uveitis: Clinical spectrum and review of literature","volume":"30","author":"Bernard","year":"2020","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.oret.2020.07.012","article-title":"Outcomes of combination systemic and intravitreal antiviral therapy for acute retinal necrosis","volume":"5","author":"Debiec","year":"2021","journal-title":"Ophthalmol. Retina"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Agrawal, R., Betzler, B.K., Testi, I., Mahajan, S., Agarwal, A., Gunasekeran, D.V., Raje, D., Aggarwal, K., Murthy, S.I., and Westcott, M. (2020). The collaborative ocular tuberculosis study (COTS)-1: A multinational review of 447 patients with tubercular intermediate uveitis and panuveitis. Ocul. Immunol. Inflamm., 1\u201311.","DOI":"10.1080\/09273948.2020.1808226"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1007\/s10792-020-01285-9","article-title":"Multimodal imaging patterns of posterior syphilitic uveitis: A review of the literature, laboratory evaluation and treatment","volume":"40","author":"Pichi","year":"2020","journal-title":"Int. Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1080\/09273948.2016.1249375","article-title":"Clinical profile, treatment, and visual outcome of ocular toxocara in a tertiary eye care centre","volume":"26","author":"Sahu","year":"2018","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1097\/APO.0000000000000244","article-title":"Ocular toxoplasmosis in a tertiary referral center in Sydney Australia: Clinical features, treatment, and prognosis","volume":"8","author":"Yates","year":"2019","journal-title":"Asia-Pac. J. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1080\/09273948.2016.1269931","article-title":"The use of topical non-steroidal anti-inflammatory drugs for uveitic cystoid macular edema","volume":"26","author":"Petrushkin","year":"2018","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1007\/s00417-013-2309-4","article-title":"Bromfenac alone or with single intravitreal injection of bevacizumab or triamcinolone acetonide for treatment of uveitic macular edema","volume":"251","author":"Radwan","year":"2013","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"147","DOI":"10.2147\/OPTH.S4684","article-title":"Treatment of cystoid macular edema with the new-generation NSAID nepafenac 0.1%","volume":"3","author":"Hariprasad","year":"2009","journal-title":"Clin. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kawali, A., Srinivasan, S., Mahendradas, P., and Shetty, R. (2021). Topical interferon in recurrent inflammatory macular edema following a cat bite. Eur. J. Ophthalmol.","DOI":"10.1177\/11206721211024809"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1586\/1744666X.2016.1166052","article-title":"Progress in the understanding and utilization of biologic response modifiers in the treatment of uveitis","volume":"12","author":"Maleki","year":"2016","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_17","first-page":"453","article-title":"Topical interferon alpha 2b in the treatment of refractory diabetic macular edema","volume":"15","author":"Maleki","year":"2020","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13063-020-4066-0","article-title":"Comparison of two techniques used in routine care for the treatment of inflammatory macular oedema, subconjunctival triamcinolone injection and intravitreal dexamethasone implant: Medical and economic importance of this randomized controlled trial","volume":"21","author":"Couret","year":"2020","journal-title":"Trials"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.18240\/ijo.2020.07.11","article-title":"Subconjunctival injections of triamcinolone acetonide to treat uveitic macular edema","volume":"13","author":"Qu","year":"2020","journal-title":"Int. J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"125","DOI":"10.4103\/0974-9233.148364","article-title":"Conjunctival necrosis following a subconjunctival injection of triamcinolone acetonide in a child","volume":"22","author":"Shatriah","year":"2015","journal-title":"Middle East Afr. J. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/S0002-9394(03)00320-9","article-title":"Conjunctival ulceration following triamcinolone injection","volume":"136","author":"Agrawal","year":"2003","journal-title":"Am. J. Ophthalmol."},{"key":"ref_22","first-page":"1249","article-title":"Sub-tenon steroid injection for optic neuritis","volume":"74","author":"Smith","year":"1970","journal-title":"Trans. Am. Acad. Ophthalmol. Otolaryngol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/0002-9394(75)90280-9","article-title":"Inadvertent injection of corticosteroid into the choroidal vasculature","volume":"80","author":"McLean","year":"1975","journal-title":"Am. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.ajo.2007.12.010","article-title":"Intraocular pressure elevation after injection of triamcinolone acetonide: A multicenter retrospective case-control study","volume":"145","author":"Inatani","year":"2008","journal-title":"Am. J. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1080\/02713683.2020.1826979","article-title":"Anterior migration of triamcinolone acetonide after posterior subtenon injection for macular edema predisposes to intraocular pressure elevation","volume":"46","author":"Yang","year":"2021","journal-title":"Curr. Eye Res."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Maeda, Y., Ishikawa, H., Nishikawa, H., Shimizu, M., Kinoshita, T., Ogihara, R., Kitano, S., Yamanaka, C., Mitamura, Y., and Sugimoto, M. (2019). Intraocular pressure elevation after subtenon triamcinolone acetonide injection; Multicentre retrospective cohort study in Japan. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0226118"},{"key":"ref_27","first-page":"85","article-title":"Ocular complications after a sub-tenon injection of triamcinolone acetonide for uveitis","volume":"28","author":"Kuo","year":"2005","journal-title":"Chang Gung Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/j.ophtha.2020.01.006","article-title":"Efficacy and safety of suprachoroidal CLS-TA for macular edema secondary to noninfectious uveitis: Phase 3 randomized trial","volume":"127","author":"Yeh","year":"2020","journal-title":"Ophthalmology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/S0008-4182(05)80119-X","article-title":"Complications of intravitreal injection of triamcinolone acetonide","volume":"40","year":"2005","journal-title":"Can. J. Ophthalmol."},{"key":"ref_30","first-page":"559","article-title":"Incidence of endophthalmitis after intravitreal injections: Risk factors, microbiology profile, and clinical outcomes","volume":"26","author":"Mishra","year":"2018","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"312","DOI":"10.3928\/23258160-20210528-03","article-title":"Rates of suspected endophthalmitis following intravitreal injections in clinical practices in the United States","volume":"52","author":"Dhoot","year":"2021","journal-title":"Ophthalmic Surg. Lasers Imaging Retin."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.2147\/OPTH.S82562","article-title":"Sterile endophthalmitis rates and particle size analyses of different formulations of triamcinolone acetonide","volume":"9","author":"Dodwell","year":"2015","journal-title":"Clin. Ophthalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.18240\/ijo.2020.10.16","article-title":"Complications of dexamethasone implants: Risk factors, prevention, and clinical management","volume":"13","author":"Celik","year":"2020","journal-title":"Int. J. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1001\/archophthalmol.2010.339","article-title":"Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis","volume":"129","author":"Lowder","year":"2011","journal-title":"Arch. Ophthalmol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.ophtha.2018.08.021","article-title":"Periocular triamcinolone vs. intravitreal triamcinolone vs. intravitreal dexamethasone implant for the treatment of uveitic macular edema: The PeriOcular vs. INTravitreal corticosteroids for uveitic macular edema (POINT)","volume":"126","author":"Thorne","year":"2019","journal-title":"Trial. Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1007\/s00417-016-3394-y","article-title":"Two-year, prospective, multicenter study of the use of dexamethasone intravitreal implant for treatment of macular edema secondary to retinal vein occlusion in the clinical setting in France","volume":"254","author":"Korobelnik","year":"2016","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1016\/j.ophtha.2020.04.001","article-title":"Effect of a fluocinolone acetonide insert on recurrence rates in noninfectious intermediate, posterior, or panuveitis: Three-year results","volume":"127","author":"Jaffe","year":"2020","journal-title":"Ophthalmology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1001\/archopht.126.9.1191","article-title":"Treatment of posterior uveitis with a fluocinolone acetonide implant: Three-year clinical trial results","volume":"126","author":"Callanan","year":"2008","journal-title":"Arch. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"37","DOI":"10.2147\/JIR.S5706","article-title":"Etiology and treatment of the inflammatory causes of cystoid macular edema","volume":"2","author":"Cho","year":"2009","journal-title":"J. Inflamm. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/j.ophtha.2020.11.011","article-title":"Risk of inflammation, retinal vasculitis, and retinal occlusion-related events with brolucizumab: Post hoc review of HAWK and HARRIER","volume":"128","author":"Srivastava","year":"2021","journal-title":"Ophthalmology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/j.ophtha.2017.12.002","article-title":"Efficacy and safety of ranibizumab 0.5 mg for the treatment of macular edema resulting from uncommon causes: Twelve-month findings from PROMETHEUS","volume":"125","author":"Staurenghi","year":"2018","journal-title":"Ophthalmology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1089\/jop.2016.0118","article-title":"Intravitreal antiangiogenic therapy of uveitic macular edema: A review","volume":"33","author":"Kozak","year":"2017","journal-title":"J. Ocul. Pharmacol. Ther."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e922","DOI":"10.1111\/aos.14451","article-title":"Intravitreal aflibercept for treatment of macular oedema associated with immune recovery uveitis","volume":"98","author":"Rothova","year":"2020","journal-title":"Acta Ophthalmol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/j.ophtha.2008.10.033","article-title":"Intraocular methotrexate in the treatment of uveitis and uveitic cystoid macular edema","volume":"116","author":"Taylor","year":"2009","journal-title":"Ophthalmology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1097\/IAE.0b013e31828ac07d","article-title":"Intraocular methotrexate can induce extended remission in some patients in noninfectious uveitis","volume":"33","author":"Taylor","year":"2013","journal-title":"Retina"},{"key":"ref_46","first-page":"3","article-title":"The effect of different dosing schedules of intravitreal sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, in the treatment of non-infectious uveitis (An American Ophthalmological Society Thesis)","volume":"114","author":"Nguyen","year":"2016","journal-title":"Trans. Am. Ophthalmol. Soc."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"277","DOI":"10.4103\/0301-4738.114099","article-title":"Medical Management of Uveitis\u2014Current Trends","volume":"61","author":"Babu","year":"2013","journal-title":"Indian J. Ophthalmol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e14668","DOI":"10.1097\/MD.0000000000014668","article-title":"Real-world evidence of treatment for relapse of noninfectious uveitis in tertiary centers in Japan: A multicenter study","volume":"98","author":"Takeuchi","year":"2019","journal-title":"Medicine"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1016\/j.semarthrit.2020.08.010","article-title":"Efficacy and safety of immunomodulatory drugs in patients with non-infectious intermediate and posterior uveitis, panuveitis and macular edema: A systematic literature review","volume":"50","author":"Loza","year":"2020","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1080\/09286580701585892","article-title":"Methods for identifying long-term adverse effects of treatment in patients with eye diseases: The systemic immunosuppressive therapy for eye diseases (SITE) cohort study","volume":"15","author":"Kempen","year":"2008","journal-title":"Ophthalmic Epidemiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.ophtha.2013.09.023","article-title":"Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Incidence of visual improvement in uveitis cases with visual impairment caused by macular edema","volume":"121","author":"Levin","year":"2014","journal-title":"Ophthalmology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1136\/bmj.b2480","article-title":"Overall and cancer related mortality among patients with ocular inflammation treated with immunosuppressive drugs: Retrospective cohort study","volume":"339","author":"Kempen","year":"2009","journal-title":"BMJ"},{"key":"ref_53","first-page":"CD012577","article-title":"Anti-tumour necrosis factor biological therapies for the treatment of uveitic macular oedema (UMO) for non-infectious uveitis","volume":"12","author":"Barry","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1007\/s10792-017-0592-5","article-title":"Adalimumab in refractory cystoid macular edema associated with birdshot chorioretinopathy","volume":"38","author":"Steeples","year":"2018","journal-title":"Int. Ophthalmol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.ajo.2013.05.002","article-title":"Interferon versus methotrexate in intermediate uveitis with macular edema: Results of a randomized controlled clinical trial","volume":"156","author":"Mackensen","year":"2013","journal-title":"Am. J. Ophthalmol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1136\/bjo.2006.101550","article-title":"Efficacy of interferon alpha in the treatment of refractory and sight threatening uveitis: A retrospective monocentric study of 45 patients","volume":"91","author":"Bodaghi","year":"2007","journal-title":"Br. J. Ophthalmol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S0161-6420(02)01969-3","article-title":"Intraocular concentration and pharmacokinetics of triamcinolone acetonide after a single intravitreal injection","volume":"110","author":"Beer","year":"2003","journal-title":"Ophthalmology"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"402","DOI":"10.5935\/0004-2749.20200079","article-title":"Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: A prospective, randomized clinical study","volume":"83","author":"Shalaby","year":"2020","journal-title":"Arq. Bras. Oftalmol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1080\/17425255.2017.1404987","article-title":"Pharmacokinetics of intravitreal anti-VEGF drugs in vitrectomized versus non-vitrectomized eyes","volume":"13","author":"Edington","year":"2017","journal-title":"Expert Opin. Drug Metab. Toxicol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1016\/j.ophtha.2015.07.005","article-title":"The association between intravitreal steroids and post-injection endophthalmitis rates","volume":"122","author":"VanderBeek","year":"2015","journal-title":"Ophthalmology"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1177\/1120672119899379","article-title":"Risk factors for ocular complications in adult patients with uveitis","volume":"30","year":"2020","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Bolletta, E., Coassin, M., Iannetta, D., Mastrofilippo, V., Aldigeri, R., Invernizzi, A., de Simone, L., Gozzi, F., De Fanti, A., and Cappella, M. (2021). Cataract surgery with intraocular lens implantation in juvenile idiopathic arthritis-associated uveitis: Outcomes in the era of biological therapy. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112437"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/18\/4133\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:02:20Z","timestamp":1760166140000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/18\/4133"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,14]]},"references-count":62,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["jcm10184133"],"URL":"https:\/\/doi.org\/10.3390\/jcm10184133","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,14]]}}}