The Efficacy Of Clinical Research In Uveitis Secondary To Cystoid Macular Edema

Objective:In this study,we used Topcon DRI optical coherence tomography(OCT)to follow-up and observe the efficacy、prognosis and correlated factors of cystoid macular edema(CME)secondary to uveitis.Methods:1.A retrospective,noncomparative case series study.2.The clinical data of uveitis patients with CME were collected from Uveitis & Ocular Immunology Service of Tianjin Medical University Eye Hospital from August 2015 to December 2016.We reviewed medical records of 27 patients(36 eyes)with CME who were treated with systemic medication and/or periocular corticosteroids injection or intravitreal injection of corticosteroid or anti-VEGF agent,and were followed up at least 6 months.3.Pre-treatment and post-treatment Data were collected,including details of best-corrected visual acuity(BCVA),central macular thickness(CMT),duration of uveitis,duration of CME,intraocular pressure(IOP),CME recession,Inflammation,and complications of macular epiretinal membrane(ERM).Results:1.Vision analysis of pre-treatment and post-treatment:At the 6st month after treatment,significant difference was found in BCVA of pre-treatment and post-treatment(t=5.944,P<0.001).Thirty-three eyes(91.7%)responded with improvement in vision,of which twenty eyes(55.6%)responded with improvement≥0.3logMAR units in vision.2.CMT changes of pre-treatment and post-treatment:At the 6st month after treatment,significant difference was found in CMT of pre-treatment and post-treatment(t=4.385,P<0.001).Eight eyes(22.2%)decreased in thickness of CMT at >50%,fourteen eyes(38.9%)decreased in thickness of CMT at 30%~50%,twelve eyes(33.3%)decreased in thickness of CMT at between 20% ~30%,two eyes(5.6%)decreased in thickness of CMT at < 20%.3.CME resolution of pre-treatment and post-treatment:At the 1st month after treatment,complete resolution of CME was achieved in fourteen eyes(38.9%),persistence exist of CME was found in twenty two eyes(61.1%).At the 3st month after treatment,complete resolution of CME was found in nineteen eyes(52.8%),persistence exist of CME was achieved in seventeen eyes(47.2%).At the end of the observation(≥six months),complete resolution of CME was achieved in twenty five eyes(69.4%),persistence exist of CME was found in eleven eyes(30.6%).4.Correlation analysis:Pre-treatment of BCVA and CMT were negatively correlated(r=-0.372,P=0.023),Post-treatment of BCVA and CMT were negatively correlated(r=-0.493,P=0.002).A weak but statistically significant correlation between the reduction of CMT(185.0±114.2)um and the improvement of BCVA(0.29±0.21)logMAR was found(r=0.386,P=0.018),while the improvement of BCVA(0.29±0.21)logMAR was negatively associated with the duration of CME(8.4±9.8m)(r=-0.444,P=0.006).The duration of CME and the duration of uveitis were positive correlation(r=0.659,P<0.0001).5.The relationship between macular epiretinal membrane(ERM)and resolution of CME: Fundus biomicroscopy detected ERM in fifteen eyes at the beginning of the treatment.Eleven eyes with ERM(73.3%)at diagnosis had persistent macular edema.Conversely,only two(9.5%)of twenty one eyes without ERM at baseline had macular edema,while nineteen eyes had complete resolution at the end of the follow-up period.The difference was statistically significant(X2=23.31,P<0.001).6.Existence of ERM affected BCVA and CMT: Significant difference was found between fifteen eyes with ERM and twenty-one eyes without ERM of Pre-treatment BCVA(t=2.741,P<0.05),Post-treatment BCVA(t=4.534,P<0.001),and increased ranges of BCVA(t=3.525,P<0.05).No significant difference was found between the fifteen eyes with ERM and twenty-one eyes without ERM of Pre-treatment CMT(t=0.346,P>0.05),of increased ranges CMT(t=0.852,P>0.05),while significant difference was found between fifteen eyes with ERM and twenty-one eyes without ERM of Post-treatment CMT(t=2.744,P<0.05).7.Intraocular pressure(IOP)changes of Pre-treatment and post-treatment: At the 6st month after treatment,no significant difference was found in BCVA(t=0.266,P>0.05)of pre-treatment and post-treatment.During the treatment,elevation of IOP over 21 mmHg was observed two eyes of one patient,which were well controlled by topical IOP lowering drugs.Conclusion:1.Current therapies are effective in curing most of the CME secondary to uveitis,and improving vision.2.The degree of improved vision is negatively correlated with duration of CME,while positively correlated with the degree of decreased CMT.The presence of ERM is an important factor associated with regression of CME.3.Topcon DRI.OCT examination is a highly sensitive,convenient operation and high dependency of technology,the follow-up of the same pathological changes at different times,and provide reliable evaluation of curative effect.