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DOI: 10.1055/a-1124-6732
Makulaödem bei Uveitis: Pathogenese, Diagnostik und Therapie
Macular Oedema in Uveitis: Pathogenesis, Diagnosis, and TreatmentPublikationsverlauf
eingereicht 17. Februar 2020
akzeptiert 12. März 2020
Publikationsdatum:
20. Mai 2020 (online)
![](https://www.thieme-connect.de/media/klimo/202005/lookinside/thumbnails/10-1055-a-1124-6732_kl2165-1.jpg)
Zusammenfassung
Das Makulaödem ist die häufigste Ursache einer irreversiblen Visusminderung bei Patienten mit Uveitis. Pathogenetisch führen proinflammatorische Zytokine zu einem Zusammenbruch der Blut-Retina-Schranke. Zur Diagnostik des entzündlichen Makulaödems wird heutzutage überwiegend die optische Kohärenztomografie eingesetzt, welche die Fluoreszenzangiografie jedoch nicht immer zu ersetzen vermag. Die Therapie erfolgt überwiegend mittels intravitreal applizierter Kortikosteroide sowie systemischer immunmodulierender Substanzen und sollte so früh wie möglich einsetzen, um einer Chronifizierung des Makulaödems vorzubeugen.
Abstract
Macular oedema is the most common cause of irreversible visual loss in patients with uveitis. The pathogenesis is caused by pro-inflammatory cytokines that lead to the breakdown of the blood-retina barrier. For the diagnosis of inflammatory macular oedema, optical coherence tomography is now mainly used, but cannot always replace fluorescein angiography. The therapy is mainly performed with intravitreally applied corticosteroids as well as systemic immunomodulators and should start as early as possible to prevent chronification of macular oedema.
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Literatur
- 1 Grajewski RS, Boelke AC, Adler W. et al. Spectral-domain optical coherence tomography findings of the macula in 500 consecutive patients with uveitis. Eye (Lond) 2016; 30: 1415-1423
- 2 Daruich A, Matet A, Moulin A. et al. Mechanisms of macular edema: beyond the surface. Prog Retin Eye Res 2018; 63: 20-68
- 3 Wakefield D, Lloyd A. The role of cytokines in the pathogenesis of inflammatory eye disease. Cytokine 1992; 4: 1-5
- 4 Grajewski RS, Heindl LM. Macular thickening of uveitic eyes in the absence of macular oedema and epiretinal membranes. Acta Ophthalmol 2017; 95: e77-e78
- 5 Bringmann A, Reichenbach A, Wiedemann P. Pathomechanisms of cystoid macular edema. Ophthalmic Res 2004; 36: 241-249
- 6 Hikichi T, Trempe CL. Role of the vitreous in the prognosis of peripheral uveitis. Am J Ophthalmol 1993; 116: 401-405
- 7 Guex-Crosier Y. The pathogenesis and clinical presentation of macular edema in inflammatory diseases. Doc Ophthalmol 1999; 97: 297-309
- 8 van Kooij B, Fijnheer R, Roest M. et al. Trace microalbuminuria in inflammatory cystoid macular edema. Am J Ophthalmol 2004; 138: 1010-1015
- 9 Thorne JE, Daniel E, Jabs DA. et al. Smoking as a risk factor for cystoid macular edema complicating intermediate uveitis. Am J Ophthalmol 2008; 145: 841-846
- 10 Tran TH, de Smet MD, Bodaghi B. et al. Uveitic macular oedema: correlation between optical coherence tomography patterns with visual acuity and fluorescein angiography. Br J Ophthalmol 2008; 92: 922-927
- 11 Markomichelakis NN, Halkiadakis I, Pantelia E. et al. Patterns of macular edema in patients with uveitis. Ophthalmology 2004; 111: 946-953
- 12 Kempen JH, Sugar EA, Jaffe GJ. et al. Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema. Ophthalmology 2013; 120: 1852-1859
- 13 Khochtali S, Abroug N, Megzari K. et al. Swept-source optical coherence tomography angiography findings in uveitic cystoid macular edema. Ocul Immunol Inflamm 2019; 27: 1211-1223
- 14 Roesel M, Henschel A, Heinz C. et al. Fundus autofluorescense and spectral domain optical coherence tomography in uveitic macular edema. Graefes Arch Clin Exp Ophthalmol 2009; 247: 1685-1689
- 15 Rothova A. Medical treatment of cystoid macular edema. Ocul Immunol Inflamm 2003; 10: 239-246
- 16 Heiligenhaus A, Bertram B, Heinz C. et al. Stellungnahme der Deutschen Ophthalmologischen Gesellschaft, der Retinologischen Gesellschaft und des Berufsverbandes der Augenärzte Deutschlands zur intravitrealen Therapie des Makulaödems bei Uveitis (Stand: 02.07.2014). Klin Monatsbl Augenheilkd 2014; 231: 929-936
- 17 Thurau SR. Cystoid macular edema in uveitis. Ophthalmologe 2005; 102: 485-490
- 18 Petrushkin H, Rogers D, Paversio C. The use of topical non-steroidal anti-inflammatory drugs for uveitic cystoid macular edema. Ocul Immunol Inflamm 2018; 26: 795-797
- 19 Al-Dhibi H, Hamade IH, Al-Halafi A. et al. The effects of intravitreal bevacizumab in infectious and noninfectious uveitic macular edema. J Ophthalmol 2014; 2014: 729465
- 20 Reddy AK, Cabrera M, Yeh S. et al. Optical coherence tomography-guided ranibizumab injection for cystoid macular edema in well-controlled uveitis: twelve-month outcomes. Retina 2014; 34: 2431-2438
- 21 Marmor MF, Maack T. Enhancement of retinal adhesion and subretinal fluid resorption by acetazolamide. Invest Ophthalmol Vis Sci 1982; 23: 121-124
- 22 Schilling H, Heiligenhaus A, Laube T. et al. Long-term effect of acetazolamide treatment of patients with uveitic chronic cystoid macular edema is limited by persisting inflammation. Retina 2005; 25: 182-188
- 23 Zierhut M, Thiel HJ, Schlote T. Treatment of uveitic macular edema with acetazolamide. Doc Ophthalmol 1999; 97: 409-413
- 24 Leder HA, Jabd DA, Galor A. et al. Periocular triamcinolon acetonide injections for cystoid macular edema complicating noninfectious uveitis. Am J Ophthalmol 2011; 152: 441-448
- 25 Koronis S, Stavrakas P, Balidis M. Update in treatment of uveitic macular edema. Drug Des Devel Ther 2019; 19: 667-680
- 26 Lowder C, Belfort R, Lightman S. et al. Dexamethasone intravitreal implant for non-infectious intermediate or posterior uveitis. Arch Ophthalmol 2011; 129: 545-553
- 27 Adán A, Pelegrin L, Rey A. et al. Dexamethasone intravitreal implant for the treatment of uveitic persistent cystoid macular edema in vitrectomized patients. Retina 2013; 33: 1435-1440
- 28 Jaffe GJ. Treatment of non-infectious uveitis that affects the posterior segment with a single intravitreal fluocinolone acetonide insert (FAi) – 3 year results. ARVO Annual Meeting 2019; Abstract Nr. 3858.
- 29 Neri P, Mariotti C, Cimino L. et al. Long-term control of cystoid macular oedema in non-infectious uveitis with mycophenolate mofetil. Int Ophthalmol 2009; 29: 127-133
- 30 Doycheva D, Zierhut M, Blumenstock G. et al. Mycophenolate mofetil in the therapy of uveitic macular edema – long-term results. Ocul Immunol Inflamm 2012; 20: 203-211
- 31 Lejoyeux R, Diwo E, Vallet H. et al. Infliximab and adalimumab in uveitic macular edema. Ocul Immunol Inflamm 2018; 26: 991-996
- 32 Tosi GM, Sota J, Vitale A. et al. Efficacy and safety of certolizumab pegol and golimumab in the treatment of non-infectious uveitis. Clin Exp Rheumatol 2019; 37: 680-683
- 33 Deuter CME, Zierhut M, Igney-Oertel A. et al. Tocilizumab in uveitic macular edema refractory to previous immunomodulatory treatment. Ocul Immunol Inflamm 2017; 25: 215-220
- 34 Mesquida M, Molins B, Llorenc V. et al. Twenty-four month follow-up of tocilizumab therapy for refractory uveitis-related macular edema. Retina 2018; 38: 1361-1370
- 35 Quesada-Masachs E, Caballero CM. Subcutaneous tocilizumab may be less effective than intravenous tocilizumab in the treatment of juvenile idiopathic arthritis-associated uveitis. J Rheumatol 2017; 44: 260-261
- 36 Deuter CM, Kötter I, Günaydin I. et al. Efficacy and tolerability of interferon alpha treatment in patients with chronic cystoid macular oedema due to non-infectious uveitis. Br J Ophthalmol 2009; 93: 906-913
- 37 Stiefel HC, Kopplin LJ, Albini T. et al. Treatment of refractory cystoid macular edema with pegylated interferon alfa-2a: a retrospective chart review. Ocul Immunol Inflamm 2019; DOI: 10.1080/09273948.2019.1687729.
- 38 Mackensen F, Jakob E, Springer C. et al. Interferon versus methotrexate in intermediate uveitis with macular edema: results of a randomized controlled clinical trial. Am J Ophthalmol 2013; 156: 478-486
- 39 Qian Z, Fardeau C, Cardoso JN. et al. Effect of interferon α2a in cystoid macular edema due to intraocular infection. Eur J Ophthalmol 2015; 25: 431-436
- 40 Becker MD, Harsch N, Zierhut M. et al. [Therapeutic vitrectomy in uveitis. Current status and recommendations]. Ophthalmologe 2003; 100: 787-795
- 41 Wiechens B, Reichelt JA, Urbat C. et al. [Pars plana vitrectomy in cystoid macular edema of different forms of chronic uveitis]. Ophthalmologe 2003; 100: 33-43
- 42 Gutfleisch M, Spital G, Mingels A. et al. Pars plana vitrectomy with intravitreal triamcinolone: effect on uveitic cystoid macular oedema and treatment limitations. Br J Ophthalmol 2007; 91: 345-348