The role of steroids in the management of uveitic macular edema

Purpose. To review the role of steroids in the management of uveitic macular edema. Methods. Review of recent literature on the physiopathology of macular edema and clinical trials involving steroids as main treatment of uveitic macular edema. Results. The steroid-glucocorticoid receptor complex regulates the action of specific steroids allowing transactivation or repression of a common as well as a unique set of genes. This specificity may help explain differences observed in the side effect profile of commonly used intraocular steroids (dexamethasone, fluocinolone, triamcinolone) whose ability to activate glucocorticoid receptors in model systems is very similar. Sustained delivery devices provide long-term remission of macular edema but with an increased incidence of cataract and glaucoma procedures. The exact incidence is dependent on the specific steroid, the mode of delivery, and the time since injection/placement. Steroid therapy is able to target many important pathways in uveitic macular edema, achieving good clinical results. Secondary adverse effects are still a matter of concern limiting their use. Conclusions. Steroid therapy remains a mainstay in the management of uveitic macular edema. Local administration precludes systemic adverse effects even though the risk of developing cataract or glaucoma remains an important issue. New slow release devices are thought to improve safety profile while keeping therapeutic advantages