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Mechanisms of macular edema - PubMed

  • ️Sun Jan 01 2023

Review

Mechanisms of macular edema

Cameron D Haydinger et al. Front Med (Lausanne). 2023.

Abstract

Macular edema is the pathological accumulation of fluid in the central retina. It is a complication of many retinal diseases, including diabetic retinopathy, retinal vascular occlusions and uveitis, among others. Macular edema causes decreased visual acuity and, when chronic or refractory, can cause severe and permanent visual impairment and blindness. In most instances, it develops due to dysregulation of the blood-retinal barrier which permits infiltration of the retinal tissue by proteins and other solutes that are normally retained in the blood. The increase in osmotic pressure in the tissue drives fluid accumulation. Current treatments include vascular endothelial growth factor blockers, corticosteroids, and non-steroidal anti-inflammatory drugs. These treatments target vasoactive and inflammatory mediators that cause disruption to the blood-retinal barrier. In this review, a clinical overview of macular edema is provided, mechanisms of disease are discussed, highlighting processes targeted by current treatments, and areas of opportunity for future research are identified.

Keywords: diabetic retinopathy; human; macula; macular edema; retina; retinal vein occlusion; uveitis.

Copyright © 2023 Haydinger, Ferreira, Williams and Smith.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1

Optical coherence tomography (OCT) scans of the human macula in cross-section. (A) Healthy macula. (B) Macula of a patient with mild uveitic macular edema showing small numbers of cystic spaces in the inner retina (asterisk) and limited subretinal fluid (arrowhead). (C) Macula of a patient with severe uveitic macular edema demonstrating extensive retinal cystic changes (asterisk) and subretinal fluid (arrowhead).

Figure 2
Figure 2

Diagrams of the inner and outer blood-retinal barriers (BRB). (A) Schematic cross-section of a retinal capillary indicating the location of junctions between retinal endothelial cells which form the inner BRB, along with surrounding cell types. (B) Diagram of the outer portion of the retina and choroid, indicating the junctions between retinal pigment epithelial (RPE) cells which form the outer BRB, along with surrounding structures.

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