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O edema macular uveĆtico corresponde Ć complicaĆ§Ć£o mais frequente da uveĆte. Quando presente, determina uma importante diminuiĆ§Ć£o da acuidade visual dos doentes afetados, com um impacto negativo significativo na sua qualidade de vida. A sua patogĆ©nese deve-se em grande parte ao aumento da permeabilidade da barreira hemato-retiniana (BHR) decorrente do processo inflamatĆ³rio. Neste contexto verificase acumulaĆ§Ć£o de fluĆdos e proteĆnas, com consequente aumento da espessura macular central. O seu diagnĆ³stico com recurso a tomografia de coerĆŖncia Ć³tica (OCT) deve ser realizado no menor espaƧo de tempo possĆvel, por forma a dar inĆcio ao seu tratamento e evitar o desenvolvimento de alteraƧƵes estruturais irreversĆveis que poderĆ£o estar na base da sua cronicidade apesar de uveĆte quiescente. Os corticĆ³ides, administrados localmente ou sistemicamente, continuam a constituir a base terapĆŖutica do tratamento da uveĆte de etiologia nĆ£o infeciosa, tendo-se verificado nos Ćŗltimos anos um desenvolvimento crescente de implantes de libertaĆ§Ć£o prolongada de fĆ”rmacos desta classe, com o intuito de reduzir a frequĆŖncia da sua administraĆ§Ć£o e reexposiĆ§Ć£o aos seus efeitos adversos. A intolerĆ¢ncia aos mesmos, presenƧa de contraindicaƧƵes ou necessidade de um efeito poupador de corticĆ³ides tĆŖm incentivado a pesquisa de altenativas terapĆŖuticas, designadamente de agentes biolĆ³gicos. Apesar dos resultados promissores, a sua utilizaĆ§Ć£o no tratamento do edema macular uveĆto verifica-se ainda muitas vezes off-label, realƧando a necessidade de realizaĆ§Ć£o estudos.
Uveitic macular edema is the most frequent complication of uveitis. When present, it leads to a meaningful decrease of visual acuity of the affected patients and significant negative impact on their quality of life. Its pathogenesis is primarily related to the increased permeability of the blood-retinal barrier induced by the inflammatory response. This leads to protein and fluid accumulation and therefore increase of the central macular thickness. Diagnosis based on imaging examination with optical coherence tomography should be performed at the earliest opportunity, in order to begin treatment and avoid the establishment of permanent structural changes, that may be behind long-standing macular edema despite quiescent uveitis. Local or systemic corticosteroid therapy remains the mainstay of treatment for noninfectious uveitis, with substantial progresses being done in the development of sustainedrelease steroid implants, meant to reduce the frequency of its administration and reexposure to its side affects. The presence of intolerance, contraindications as well as the need for corticosteroid-sparing effect have promoted the investment on the research for alternative therapies, namely biologic agents. Despite promising results, their use for the treatment of uveitic macular edema is still frequently off-label, highlighting the need for studies.
Uveitic macular edema is the most frequent complication of uveitis. When present, it leads to a meaningful decrease of visual acuity of the affected patients and significant negative impact on their quality of life. Its pathogenesis is primarily related to the increased permeability of the blood-retinal barrier induced by the inflammatory response. This leads to protein and fluid accumulation and therefore increase of the central macular thickness. Diagnosis based on imaging examination with optical coherence tomography should be performed at the earliest opportunity, in order to begin treatment and avoid the establishment of permanent structural changes, that may be behind long-standing macular edema despite quiescent uveitis. Local or systemic corticosteroid therapy remains the mainstay of treatment for noninfectious uveitis, with substantial progresses being done in the development of sustainedrelease steroid implants, meant to reduce the frequency of its administration and reexposure to its side affects. The presence of intolerance, contraindications as well as the need for corticosteroid-sparing effect have promoted the investment on the research for alternative therapies, namely biologic agents. Despite promising results, their use for the treatment of uveitic macular edema is still frequently off-label, highlighting the need for studies.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Keywords
Edema macular uveĆtico Tratamento Implante intravĆtreo de dexametasona Anti-VEGF Agentes biolĆ³gicos Oftalmologia