title: Drug-induced macular edema.
abstract: Macular edema constitutes a serious pathologic entity of ophthalmology resulting in vision loss with a remarkable impact on the quality of life of patients. It is the final common pathway of various systemic diseases and underlying intraocular conditions, with diabetes mellitus being the most frequent cause. Other causes include venous occlusive disease, intraocular surgery, and inflammatory conditions of the posterior segment of the eye. Macular edema is a recognized side effect of various systemic and local medications and requires special consideration among ophthalmologists and other clinicians. Recently, antidiabetic thiazolidinediones have been implicated in the development of macular edema, and a review of the English literature revealed that other systemically administered drugs like fingolimod, recently approved for relapsing forms of multiple sclerosis, the anticancer agents tamoxifen and the taxanes, as well as niacin and interferons have been reported to cause macular edema. Ophthalmologic pharmaceutical agents, like prostaglandin analogs, epinephrine, timolol, and ophthalmic preparation preservatives have also been reported to cause macular edema as an adverse event. The purpose of this article is to provide a short, balanced overview of the available evidence in this regard. The available data and the possible pathophysiologic mechanisms leading to the development of macular edema are discussed. Possible therapeutic strategies for drug-induced macular edema are also proposed.
authors: Department of Ophthalmology, Medical School, University of Patras, Rio, 26504 Patras, Greece.
authors: Olga E
authors: OE
authors: Makri
authors: Ilias
authors: I
authors: Georgalas
authors: Constantine D
authors: CD
authors: Georgakopoulos
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000068876:Fingolimod Hydrochloride; D006801:Humans; D000960:Hypolipidemic Agents / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007372:Interferons / Q000009:adverse effects*; D008269:Macular Edema / Q000139:chemically induced* / Q000175:diagnosis; D009525:Niacin / Q000009:adverse effects; D009883:Ophthalmic Solutions / Q000009:adverse effects*; D011409:Propylene Glycols / Q000009:adverse effects; D013110:Sphingosine / Q000009:adverse effects / Q000031:analogs & derivatives; D013629:Tamoxifen / Q000009:adverse effects; D043823:Taxoids / Q000009:adverse effects; D045162:Thiazolidinediones / Q000009:adverse effects*; D013999:Timolol / Q000009:adverse effects
chemical_list: D000319:Adrenergic beta-Antagonists; D000970:Antineoplastic Agents; D000960:Hypolipidemic Agents; D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions; D011409:Propylene Glycols; D043823:Taxoids; D045162:Thiazolidinediones; D013629:Tamoxifen; D009525:Niacin; D013999:Timolol; D007372:Interferons; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine
references: Am J Ophthalmol. 1998 Apr;125(4):493-501
references: 9559735
references: Ophthalmic Surg. 1988 Aug;19(8):562-4
references: 2902544
references: Graefes Arch Clin Exp Ophthalmol. 2007 Oct;245(10):1585-6
references: 17562067
references: Korean J Ophthalmol. 2010 Oct;24(5):306-9
references: 21052512
references: Arch Ophthalmol. 2008 Jun;126(6):793-9
references: 18541841
references: Graefes Arch Clin Exp Ophthalmol. 2012 Mar;250(3):463-4
references: 21431400
references: Retin Cases Brief Rep. 2009 Winter;3(1):33-5
references: 19956779
references: Jpn J Ophthalmol. 2002 Nov-Dec;46(6):656-9
references: 12543193
references: J Ocul Pharmacol Ther. 2007 Dec;23(6):567-70
references: 18001244
references: Pharmacol Toxicol. 2002 Sep;91(3):116-22
references: 12427111
references: Semin Ophthalmol. 2002 Sep-Dec;17(3-4):181-6
references: 12759848
references: Rheumatology (Oxford). 2004 Feb;43(2):246-8
references: 14739469
references: Arch Ophthalmol. 2007 May;125(5):709-10
references: 17502517
references: Ocul Immunol Inflamm. 2010 Dec;18(6):472-4
references: 20735297
references: Leukemia. 2004 Jun;18(6):1138-9
references: 15085156
references: Arch Ophthalmol. 2004 Jun;122(6):928-30
references: 15197075
references: Diabetes Care. 2009 Jan;32(1):193-203
references: 18945920
references: Clin Exp Rheumatol. 2010 Jan-Feb;28(1 Suppl 57):90-2
references: 20412711
references: Ophthalmology. 1988 Dec;95(12):1704-5
references: 3231439
references: Ophthalmology. 1996 Jan;103(1):138-47
references: 8628544
references: Cell. 1999 Oct 29;99(3):301-12
references: 10555146
references: Clin Drug Investig. 2008;28(5):327-32
references: 18407718
references: J Cataract Refract Surg. 2001 Sep;27(9):1397-401
references: 11566522
references: Eur J Ophthalmol. 2008 Nov-Dec;18(6):1014-6
references: 18988179
references: Invest Ophthalmol Vis Sci. 2007 Jan;48(1):368-75
references: 17197556
references: Int Ophthalmol. 2009 Aug;29(4):257-9
references: 18385945
references: CMAJ. 2006 Feb 28;174(5):623
references: 16467508
references: Semin Ophthalmol. 2007 Apr-Jun;22(2):87-8
references: 17564928
references: Clin Ophthalmol. 2012;6:1341-5
references: 22969278
references: Arch Ophthalmol. 2005 Feb;123(2):186-92
references: 15710814
references: Cancer. 1992 Jun 15;69(12):2961-4
references: 1591689
references: Neurology. 2012 Feb 28;78(9):672-80
references: 22371414
references: Ophthalmology. 1999 May;106(5):1024-9
references: 10328408
references: Arch Soc Esp Oftalmol. 2010 Jul;85(7):246-8
references: 21093714
references: Am J Ophthalmol. 1987 Aug 15;104(2):185-6
references: 3039846
references: Doc Ophthalmol. 1999;97(3-4):341-7
references: 10896349
references: J Am Optom Assoc. 1998 Feb;69(2):122-8
references: 9549261
references: J Cataract Refract Surg. 2010 Aug;36(8):1380-4
references: 20656163
references: J Ocul Pharmacol Ther. 2013 Apr;29(3):360-2
references: 23061416
references: Ophthalmology. 1993 Sep;100(9):1297-304
references: 8371915
references: Arch Intern Med. 2012 Jul 9;172(13):1005-11
references: 22688528
references: Am J Ophthalmol. 2009 Apr;147(4):583-586.e1
references: 19181303
references: J Natl Cancer Inst. 2005 Nov 16;97(22):1652-62
references: 16288118
references: Cancer Treat Rep. 1978 Mar;62(3):315-20
references: 647693
references: Indian J Ophthalmol. 2010 Mar-Apr;58(2):147-8
references: 20195039
references: Retina. 2008 Mar;28(3):520-4
references: 18327149
references: Breast Cancer Res Treat. 2006 Sep;99(1):117-8
references: 16541311
references: Am J Ophthalmol. 2002 Mar;133(3):403-5
references: 11860980
references: N Engl J Med. 2010 Feb 4;362(5):402-15
references: 20089954
references: Br J Ophthalmol. 1998 Mar;82(3):323-5
references: 9602634
references: Surv Ophthalmol. 2008 Nov;53 Suppl1:S93-105
references: 19038628
references: Ophthalmology. 1988 Jul;95(7):930-6
references: 3174043
references: Eur J Ophthalmol. 2005 Jan-Feb;15(1):158-61
references: 15751259
references: Can J Ophthalmol. 2011 Apr;46(2):200-1
references: 21708093
references: J Cataract Refract Surg. 2003 Sep;29(9):1800-10
references: 14522305
references: Eye (Lond). 2007 Feb;21(2):269-71
references: 16858440
references: Am J Ophthalmol. 2004 May;137(5):966-8
references: 15126179
references: N Engl J Med. 2004 Sep 9;351(11):1106-18
references: 15356308
references: Ann Ophthalmol. 1976 Apr;8(4):455-8
references: 1267317
references: Diabet Med. 2008 Jul;25(7):860-2
references: 18644073
references: Surv Ophthalmol. 2002 Aug;47 Suppl 1:S219
references: 12204718
references: Arch Ophthalmol. 2005 Sep;123(9):1273-5
references: 16157815
references: Am J Ophthalmol. 1973 Oct;76(4):500-10
references: 4743805
references: Clin Exp Optom. 2012 Mar;95(2):233-6
references: 22023333
references: J Neurol. 2012 Feb;259(2):386-8
references: 22231867
references: Surv Ophthalmol. 1997 Feb;41 Suppl 2:S83-8
references: 9154281
references: J Neurol Sci. 2012 Dec 15;323(1-2):167-72
references: 23040960
references: Ann Intern Med. 1991 Feb 15;114(4):297-8
references: 1987876
references: Am J Ophthalmol. 1982 Nov;94(5):682
references: 7148952
references: Br J Ophthalmol. 1995 Jan;79(1):54-6
references: 7880795
references: Br J Ophthalmol. 1981 Mar;65(3):177-9
references: 7225310
references: J Glaucoma. 2000 Aug;9(4):317-21
references: 10958605
references: Retina. 2006 May-Jun;26(5):562-70
references: 16770264
references: Drug Saf. 2012 Apr 1;35(4):315-23
references: 22376166
references: Arch Intern Med. 2012 Jul 9;172(13):1011-3
references: 22688825
references: Jpn J Ophthalmol. 2005 May-Jun;49(3):231-4
references: 15944830
references: Arch Ophthalmol. 2010 Mar;128(3):312-8
references: 20212201
references: Arch Ophthalmol. 2010 Dec;128(12):1630-1; author reply 1631-2
references: 21149797
references: Korean J Ophthalmol. 2012 Apr;26(2):147-50
references: 22511844
references: J Clin Invest. 2001 Sep;108(5):689-701
references: 11544274
references: Arch Ophthalmol. 1978 Apr;96(4):625-8
references: 646688
references: Arch Ophthalmol. 1998 May;116(5):679-80
references: 9596509
references: Ophthalmic Surg Lasers Imaging. 2010 Mar 09;:1-5
references: 20337282
references: Mayo Clin Proc. 2003 Sep;78(9):1088-91
references: 12962163
references: Clin Ophthalmol. 2012;6:2105-8
references: 23269859
references: Arch Ophthalmol. 2008 Jan;126(1):140-1
references: 18195237
references: Ann Ophthalmol. 1989 Nov;21(11):420-3
references: 2619152
references: Ophthalmology. 1999 Sep;106(9):1656-9
references: 10485530
references: Am J Ophthalmol. 1998 Jul;126(1):134-5
references: 9683162
references: Am J Ophthalmol. 2003 Jun;135(6):913-4
references: 12788145
references: Am J Ophthalmol. 1975 Sep;80(3 Pt 1):379-88
references: 1163585
references: J Clin Oncol. 2010 Nov 20;28(33):e684-7
references: 20805460
references: J Int Med Res. 1999 Mar-Apr;27(2):53-64
references: 10446691
references: Am J Ophthalmol. 2002 Mar;133(3):393-7
references: 11915838
references: J Glaucoma. 2001 Jun;10(3):233-6
references: 11442189
references: Br J Ophthalmol. 1998 Jul;82(7):843-4
references: 9924387
references: J Ophthalmic Inflamm Infect. 2012 Sep;2(3):149-52
references: 22311604
references: Graefes Arch Clin Exp Ophthalmol. 1998 Sep;236(9):669-73
references: 9782427
references: Arch Ophthalmol. 2012 Jul;130(7):931-2
references: 22776935
references: Int Ophthalmol. 2012 Apr;32(2):97-8
references: 22430294
references: J Antimicrob Chemother. 2002 Feb;49(2):421-2
references: 11815593
references: Arch Ophthalmol. 1998 May;116(5):680-2
references: 9596510
references: JAMA. 1998 Jun 3;279(21):1702
references: 9624021
references: Endocr Pract. 2003 Sep-Oct;9(5):406-16
references: 14583425
references: Diabetes. 2001 May;50(5):1166-70
references: 11334422
references: Arch Ophthalmol. 2001 Jul;119(7):1077-9
references: 11448335
references: Pharmacotherapy. 2002 Jul;22(7):924-9
references: 12126225
references: J Cataract Refract Surg. 2004 Dec;30(12):2644-5
references: 15617942
references: J Diabetes Sci Technol. 2011 Jul 01;5(4):945-51
references: 21880238
references: Br J Ophthalmol. 2011 Jul;95(7):1025, 1036-7
references: 20829314
references: Arch Ophthalmol. 2001 Mar;119(3):387-94
references: 11231772
references: Arch Ophthalmol. 1968 May;79(5):552-62
references: 5646032
references: J Cataract Refract Surg. 2005 Dec;31(12):2427-8
references: 16473243
references: Invest Ophthalmol Vis Sci. 1987 Mar;28(3):482-6
references: 3557860
references: Ophthalmology. 1998 Feb;105(2):263-8
references: 9479285
references: Ophthalmology. 1998 Nov;105(11):1981-3
references: 9818590
references: Am J Ophthalmol. 2005 Oct;140(4):757-8
references: 16226541
references: Case Rep Med. 2012;2012:134636
references: 23056052
references: Graefes Arch Clin Exp Ophthalmol. 2002 May;240(5):379-86
references: 12073061
references: Can J Ophthalmol. 2006 Apr;41(2):197-200
references: 16767207
references: Curr Eye Res. 2011 Oct;36(10):867-85
references: 21819259
references: Int Ophthalmol. 2012 Jun;32(3):299-304
references: 22484725
references: Am J Ophthalmol. 1997 Nov;124(5):683-5
references: 9372723
references: J Ophthalmol. 2010;2010:690707
references: 21076526
references: Am J Transplant. 2006 Dec;6(12):2912-21
references: 17061999
references: Korean J Ophthalmol. 2012 Oct;26(5):388-90
references: 23060727
references: N Engl J Med. 2010 Feb 4;362(5):387-401
references: 20089952
references: Am J Ophthalmol. 2007 Jul;144(1):126-8
references: 17601434
references: Int Ophthalmol. 2005 Jun;26(3):101-5
references: 16983587
references: Vasc Health Risk Manag. 2008;4(5):1137-40
references: 19183764
references: Semin Ophthalmol. 2007 Jul-Sep;22(3):151-3
references: 17763235
references: Arch Ophthalmol. 1999 Jan;117(1):34-40
references: 9930158
references: Arch Ophthalmol. 1977 May;95(5):791-3
references: 860942
references: J Cataract Refract Surg. 1992 Jan;18(1):100-5
references: 1735854
references: Circ Res. 2008 Nov 7;103(10):1164-72
references: 18849324
references: Nat Neurosci. 2000 Sep;3(9):873-80
references: 10966617
references: Br J Ophthalmol. 2009 Jul;93(7):906-13
references: 19321469
references: Arch Ophthalmol. 2008 Nov;126(11):1605-6
references: 19001234
references: Optom Vis Sci. 2003 Apr;80(4):277-9
references: 12692483
references: Eur J Ophthalmol. 2003 Mar;13(2):221-2
references: 12696646
references: Jpn J Ophthalmol. 2003 Jan-Feb;47(1):110-2
references: 12586189
references: Curr Opin Ophthalmol. 2000 Apr;11(2):94-100
references: 10848227
references: Am J Ophthalmol. 1998 Oct;126(4):602-4
references: 9780112