title: Morphologic and functional evaluations during development, resolution, and relapse of uveitis-associated cystoid macular edema.
abstract: OBJECTIVE
  To describe progression and resolution of uveitis-associated cystoid macular edema (uvCME) using spectral-domain optical coherence tomography and find predictive factors for successful intravitreal triamcinolone acetonide (IVTA) therapy.
  
  
  METHODS
  Twenty-nine eyes with treatment-naive uvCME were examined before and at 5 scheduled visits within 3 months after intravitreal triamcinolone acetonide administration. Distribution, resolution, relapse, and development of uvCME were evaluated using spectral-domain optical coherence tomography to describe morphology, progression, and relapse according to a standardized reading protocol. Applying repeated measures analysis of variance, morphologic findings were evaluated as predictive factors of the treatment outcome.
  
  
  RESULTS
  At baseline, 89.3% presented with focal CME; 65.6% had outer nuclear/Henley's layer and inner nuclear layer cysts. Following intravitreal triamcinolone acetonide administration, cysts of outer nuclear/Henley's layer diminished before those of inner nuclear layer (P = 0.0004). Small-pointed subretinal detachment (SRD) resolution synchronized with inner nuclear layer cyst extinction, whereas dome-shaped SRD resolution lagged behind (P = 0.014). Relapses of CME appeared in 71.4% of eyes with parafoveal inner nuclear layer cysts. Cysts of outer nuclear/Henley's layer were present in an additional 28.6%. None of the eyes developed SRD during CME relapse. The main effect variables "SRD" and "absence of epiretinal membrane" were associated with greater best-corrected visual acuity improvement (P = 0.05 and P = 0.047), whereas the side effect variables "CME duration", "age," and "uveitis location" had no additional effect on best-corrected visual acuity. Baseline SRD predicted a relapse-free clinical course within the observational period (P = 0.025).
  
  
  CONCLUSIONS
  Different morphologic patterns in uvCME may represent different stages in uvCME progression, and initial morphologic appearance can be linked to the clinical prognosis after the treatment.
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors.forename: Marion R
authors.initials: MR
authors.lastname: Munk
authors.forename: Matthias
authors.initials: M
authors.lastname: Bolz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huf
authors.forename: Florian
authors.initials: F
authors.lastname: Sulzbacher
authors.forename: Philipp
authors.initials: P
authors.lastname: Roberts
authors.forename: Christian
authors.initials: C
authors.lastname: Simader
authors.forename: René
authors.initials: R
authors.lastname: Rückert
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Kiss
mesh_terms: D018450:Disease Progression; D019773:Epiretinal Membrane / Q000175:diagnosis*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012163:Retinal Detachment / Q000175:diagnosis*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D014606:Uveitis, Anterior / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide