A systematic review of the effectiveness of pharmacological agents for the treatment of uveitic macular oedema (UMO)

Abstract

Purpose : Macular oedema is the leading cause of sight-loss in patients with uveitis. There is no consensus over the optimal treatment of UMO. Our aim was to review systematically the effectiveness of pharmacological agents used to treat UMO.

Methods : The protocol was registered on PROSPERO (CRD42015019170). Standard methodology was employed to identify, select, extract data and assess the quality of the included studies. Bibliographic databases (Cochrane Library, MEDLINE, EMBASE and CINAHL) and clinical trials registers were searched on 10 February 2017. There were no restrictions on language of publications. The review was reported in accordance with PRISMA guidelines.

Results : 31 studies were included (25 RCTs and 6 cohort studies). In 14 studies, UMO was the target condition. In 11 studies, UMO was present in a subset of patients only; such studies frequently failed to report results from the UMO subgroup, restricting their contribution to the review.

Pharmacological agents were grouped into 6 classes with studies comparing agents to placebo, an agent within the same class or a different class.Table 1 reports the class comparison of all included studies.

20 studies assessed corticosteroids by oral (n=3), intravitreal (n=12) or other (n=5) route of administration. All forms of corticosteroid were effective ieffective (improved visual acuity and reduced macular thickness).

9 studies evaluated the use of non-corticosteroid immunomodulatory class agents, including T cell inhibitor (n=1), antimetabolites (n=2), and biological agents (n=6).

Other treatments classes evaluated carbonic anhydrase inhibitors (n=3), NSAIDs (n=3), anti-VEGF agents (n=4) and vitamin E (n=1).

Corticosteroid and immunomodulatory drugs were effective treatment for UMO; anti-VEGF had variable results; carbonic anhydrase inhibitors, NSAIDs and vitamin E were not effective.

A meta-analysis could not be undertaken due to variation in drug dosage, route of administration and study design.

Conclusions : This systematic review is the largest in the field to date that presents the available evidence to support pharmacological agents in UMO; however, it was not possible to conduct a meta-analysis on any single agent. This review also 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 in uveitis patients.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.