Etiology and treatment of macular edema.
OBJECTIVE
To summarize current concepts and recent literature regarding the pathogenesis, clinical substrates, and treatment of macular edema, in light of evolving pharmacologic and surgical approaches to this prevalent cause of vision loss.


METHODS
Interpretive essay.


METHODS
Review and synthesis of selected recent literature, with interpretation and perspective.


RESULTS
Macular edema occurs in a wide variety of pathologic conditions and represents the final common phenotype of several basic pathophysiologic processes. A variety of pharmacologic agents targeting inflammatory and vasopermeability molecules have been shown to reduce macular edema and improve visual function over the short-term. Vitreous surgery effectively addresses the tractional components of macular edema, where present. Despite recent advances, laser photocoagulation remains the treatment of choice for macular edema associated with nondiffuse patterns of vascular leakage.


CONCLUSIONS
Effective management of macular edema is based on recognizing and addressing the pathogenic factors that are operative in a given disease setting. Although treatment options are expanding with the development of new drugs and surgical procedures, the long-term efficacy and safety of most new approaches have yet to be established in controlled clinical trials.
Johnson
Mark W
MW
Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, W. K. Kellogg Eye Center, Ann Arbor, Michigan, USA. markwj@umich.edu
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D005451:Fluorescein Angiography; D006801:Humans; D017075:Laser Coagulation; D008269:Macular Edema / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology
D000893:Anti-Inflammatory Agents