Macular oedema

Smith, R.E. and Nozik, R.A. (1989). Cystoid macular oedema and uveitis. In Uveitis A Clinical Approach to Diagnosis and Management , 2nd edn. pp. 108-119. Williams and Wilkins, Baltimore. 

Chen SDM, Lochhead J, McDonald B, Patel CK. Pseudohypopyon after intravitreal triamcinolone injection for the treatment of pseudophakic cystoid macular oedema. Br J Ophthalmol 2004 88 843-4. 

Ruboxistaurin (LY333531) 41 (Eli Lilly) is being evaluated in a Phase III trial for the treatment of diabetic macular oedema.224 Lilly had submitted an NDA in February 2006 to the FDA for the treatment of diabetic retinopathy and received an Approvable Letter in September 2006 that requested another Phase III trial for additional efficacy data. The EMEA also required further clinical data and, as a consequence, Lilly withdrew its European MAA. Ruboxistaurin 41225 228 competitively inhibits adenosine triphosphate (ATP) binding to PKC/i and is a synthetic analogue of staurosporine 42. 

The retina is the most metabolically active tissue in the body and so is very vulnerable to the microvascular changes which occur in diabetes. Diabetes affects the eyes in a number of ways the most common is diabetic retinopathy, which involves increased thickness of the retinal basement membrane and increased permeability of its blood vessels. The severity of the retinopathy is related to the age of the patient, duration of the diabetic state and extent of glycaemic control. Later changes in the eye include macular oedema and retinal ischaemia, which threaten the sight of the patient. All these deleterious changes are minimized if blood glucose is tightly controlled. 

Sivaprasad S, Bunce C, Patel N. Non-steroidal anti-inflammatory agents for treating cystoid macular oedema following cataract surgery. Cochrane Database of Systematic Reviews 2004, Issue 3.Art. No. CD004239. 

Ng WT, Toohey MG, Mulhall L, Mackey DA. Pigmentary retinopathy, macular oedema, and abnormal ERG with mito-tane treatment. Br J Ophthalmol 2003 87(4) 500-l. 

Razvi FM, Kritzinger EE, Tsaloumas MD, Ryder RE. Use of oral fluorescein angiography in the diagnosis of macular oedema within a diabetic retinopathy screening programme. Diabet Med 2001 18(12) 1003-6. 

Young S, Larkin G, Branley M, Lightman S. Safety and efficacy of intravitreal triamcinolone for cystoid macular oedema in uveitis. Clin Experiment Ophthalmol 2001 29(l) 2-6. 

Greenberg PB, Martidis A, Rogers AH, Duker JS, Reichel E. Intravitreal triamcinolone acetonide for macular oedema due to central retinal vein occlusion. Br J Ophthalmol... 

Krepler K, Ergun E, Sacu S, et al.Intravitreal triamcinolone acetonide in patients with macular oedema due to central retinal vein occlusion. Acta Ophthalmol Scand 2005 83 71-75. 

Aiello LP. Medical and pharmacologic treatment of diabetic macular oedema. AAO Subspecialty Day, Anaheim CA, November 15, —vol. 18, 2003. 

Sivaprasad S, McCluskey P, Lightman S. Intravitreal steroids in the management of macular oedema. Acta Ophthalmol Scand 2006 84(6) 722-733. 

Sensory systems A case of bilateral cystoid macular oedema in a 65-year-old woman due to oral risperidone over 2 months is reported [258 ]. The postulated mechanisms included adrenoreceptor blockade or direct effect on retinal... 

This work evaluates the clinical effect of topical difluprednate in paediatric patients for treatment of noninfectious uveitis. For tiiis, retrospective, observational case series were examined. In all 26 eyes of 14 paediatric patients with noninfectious uveitis who were treated with topical difluprednate were evaluated. Anterior and posterior cell grade, visual acuity, intraocular pressure (lOP) and cystoid macular oedema (CME) were recorded at each visit. Main outcome measures were changes in anterior segment cell, CME, visual acuity, lOP and development of a visually significant cataract [21 ]. 

This trial compares aqueous levels of fluodnolone acetonide (FAc) after administration of FAc inserts or FAc implants, by comparing the pharmacokinetics from two prospective, interventional, clinical trials [28. Thirty-seven patients with diabetic macular oedema, and seven patients with uveitis participated. Aqueous FAc was measured after administration of FAc implants or 0.2 gg/day (low dose) or 0.5 gg/day (high dose) FAc inserts. The primary end point was aqueous levels of FAc. 

A 75-year-old female patient with no history of ocular disease was treated with warfarin and amiodarone due to arrhythmias that occurred after aortic valve replacement. As there were no rhythm problems, amiodarone was discontinued on day 45. Five days afterward, the patient noticed scotoma in the visual field of her left eye. After a couple of days, the patient was experiencing bilateral visual symptoms and the left eye felt foggy. A relative afferent pupillary defect was detected in the left eye and the optic nerve heads were swollen. Moreover, bilateral macular oedema was noted. Within 4 weeks of the first visual symptoms the patient had become blind. No improvement occurred during 8 months of follow-up. Other possible diagnoses were ruled out. Amiodarone-related optic neuropathy was the most likely reason for the profound visual loss [14]. 

Eyes Case-report studies have showed side effects of bilateral transient myopia and secondary ACG with choroidal detachment after use of oral methazolamide (100 mg) in a 51-year-old male with non-insulin-dependent diabetes mellitus (DM) used for refractory macular oedema after 10 days of treatment and a 70-year-old male with normoten-sive glaucoma after 1 day of treatment, which recovered with discontinuation of methazolamide [7],... 

Intravitreal injection of bevacizumab of a 45-year-old woman with bilateral diffuse diabetic macular oedema produced an initial good response in bofh eyes but vitreomacular traction developed at 30 days postinjection. Vitreomacu-lar traction was released one month after intravitreal triamcinolone injection. The authors concluded that in eyes with diabetic macular oedema and attached posterior vitreous, increased oedema and vitreomacular traction may develop after intravitreal bevacizumab [107 ]. 

In a retrospective study of 317 multiple sclerosis patients treated with fingolimod, treatment was discontinued in 30 patients (9.5%) at 3 months. Adverse effects leading to discontinuation by more than one patient included headache (n = 4), macular oedema (n=3), nausea (n = 3) and hypertension (n = 2) [24 ]. 

Ford JA, Lois N, Royle P, Clar C, Shyangdan D, Waugh N. Current treatments in diabetic macular oedema systematic review and metaanalysis. BMJ Open March 1, 2013 3(3) e002269. http //dx.doi.org/10.1136/bmjopen-2012-002269. PubMed PMID 23457327 PubMed Central PMCID PMC3612765. 

A recent study showed that approximately 20% of aphakic eyes experimentally treated with topical epinephrine responded with hyperpermeability of the iris vessels. Macular oedema in aphakic eyes treated in the same way may also be due to a generalized ocular vessel derangement (International Symposium on Fluorescein Angiography, Ghent, Belgium, 1976). 

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