Etiology and Treatment of Macular Edema

PURPOSE: 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. DESIGN: 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 pathos genic 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.