The Effectiveness of Pharmacological Agents for the Treatment of Uveitic Macular Edema (UMO): A Systematic Review

• Published in: Ocular immunology and inflammation 2019-05, Vol.27 (4), p.658-680
• Main Authors: Tallouzi, Mohammad O., Moore, David J., Barry, Robert J., Calvert, Melanie, Mathers, Jonathan, Murray, Philip I., Denniston, Alastair K.
• Format: Article
• Language: English
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - pharmacology; Glucocorticoids - therapeutic use; Humans; Macular edema; Macular Edema - drug therapy; Macular Edema - etiology; management; meta-analysis; pharmacological agents; systematic review; treatment; Treatment Outcome; uveitis; Uveitis - complications; Uveitis - drug therapy; Visual Acuity
• ISSN: 0927-3948; 1744-5078
• DOI: 10.1080/09273948.2019.1569243

Purpose: To conduct a systematic review of effectiveness of pharmacological therapies for treatment of Uveitic Macular Edema (UMO). Method/Design: Comparative studies of pharmacological therapies in patients with UMO were identified in Cochrane CENTRAL/MEDLINE/EMBASE/CINAHL/trials registers (February 2017). PROSPERO registration: CRD42015019170. Results: Thirty-one studies were included. Corticosteroids were the most frequently studied (n = 20). Corticosteroids (all forms) were consistently of greater/equal efficacy to active comparators; for anti-VEGF (n = 4) improvement, best-corrected visual acuity (BCVA) and central macular thickness (CMT) were mostly less than local corticosteroid injection; for interferon (n = 1) improvement BCVA and CMT were greater than the comparator of methotrexate; for topical indomethacin (n = 1) improvement, BCVA and CMT were greater than placebo. Non-steroidal anti-inflammatory drugs, carbonic anhydrase inhibitors, and vitamin E (n = 5) were not effective for these outcomes. Conclusion: The review highlights areas where the evidence base is still lacking, and appropriately focused trials are needed to inform best treatment to tackle this sight-threatening condition.