Topical indomethacin shows promise for acute uveitic macular edema

This prospective, randomized, double-blind, placebo-controlled clinical trial supports the use of topical indomethacin in the management of cystoid macular edema (CME) secondary to uveitis.

Particularly in young phakic patients or any patient at risk for elevated IOP with steroid use, topical indomethacin may be a viable option.

Treatment of ocular inflammation with corticosteroids often leads to resolution of CME and subsequent improvement in vision, but its use can be associated with cataract formation and elevated IOP. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to be efficacious in reducing CME related to ocular inflammation from uveitis in retrospective analyses.

The authors randomized 43 patients (68 eyes) with acute macular edema to 0.5% indomethacin eye drops or vehicle four times a day for six months.

Local treatment with mydriatic or steroid eye drops for acute anterior uveitis was allowed for up to two weeks twice during the six-month trial. Patients continued current systemic treatment without modification. By 90 days, patients treated with indomethacin showed a significant decrease in central foveal thickness (P < 0.001) and improvement in visual acuity (P < 0.001) relative to the placebo group that was maintained for the remainder of the study. Improvement in vision correlated with the central foveal thickness (P < 0.001) at six months. 

The authors conclude that it is important to treat cystoid inflammatory macular edema at a very early stage before it becomes refractory to any treatment.

The next step is to compare this formulation of indomethacin 0.5% to intravitreal injection of NSAIDs and the lower concentration of indomethacin 0.1% that has been used in previous studies of CME of various etiologies.