CARBONIC ANHYDRASE INHIBITORS FOR MANAGING UVEITIC MACULAR EDEMA: A Systematic Review And Meta-Analysis.

IF 2.1 2区医学 Q2 OPHTHALMOLOGY

Retina-The Journal of Retinal and Vitreous Diseases Pub Date : 2025-08-21 DOI:10.1097/IAE.0000000000004646

Tifanni Excelinda, Ikhwanuliman Putera, Asri Salima Ridwan, Rina La Distia Nora

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Abstract

Purpose: Uveitic macular edema (UME) is a leading cause of vision loss in uveitis. Although anti-inflammatory and immunosuppressive agents remain the mainstay of UME treatment, their use is often limited by corticosteroid-related side effects and the high cost of immunosuppressive therapies. This review aims to summarize the current evidence on carbonic anhydrase inhibitors (CAIs) as a potential treatment option for UME.

Methods: Electronic searches were conducted in PubMed/MEDLINE, Scopus, Google Scholar, Sage Journals, EBSCOhost, and the Cochrane Library for interventional and observational studies evaluating CAIs in UME. Eligible studies reported outcomes including UME resolution, recurrence, central macular thickness change, visual acuity improvement, and adverse effects. Two reviewers independently screened and extracted data, and assessed study quality and risk of bias. Meta-analysis of proportions was performed using a random-effects model. This study was registered in PROSPERO (CRD42024528004).

Results: Seven studies with a total of 187 participants (236 eyes) were included. All investigated oral acetazolamide. The pooled proportion of visual acuity improvement was 53% (95% CI: 45-60%), and anatomical improvement was 55% (95% CI: 32-79%). Acetazolamide showed a 14% higher likelihood of improving visual acuity compared to placebo, though not statistically significant (RD: 0.14; 95% CI: -0.04 to 0.31; p = 0.12).

Conclusions: CAIs, particularly oral acetazolamide, offer a potential alternative for managing UME, especially for patients who are refractory to steroids or are steroid-responders.

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碳酸酐酶抑制剂治疗葡萄膜性黄斑水肿：系统回顾和荟萃分析。

目的：葡萄膜性黄斑水肿（UME）是葡萄膜炎导致视力丧失的主要原因。虽然抗炎和免疫抑制剂仍然是UME治疗的主要药物，但它们的使用往往受到皮质类固醇相关副作用和免疫抑制疗法高成本的限制。本综述旨在总结目前关于碳酸酐酶抑制剂（CAIs）作为UME潜在治疗选择的证据。方法：在PubMed/MEDLINE、Scopus、谷歌Scholar、Sage Journals、EBSCOhost和Cochrane Library中进行电子检索，以评估UME中CAIs的介入性和观察性研究。符合条件的研究报告的结果包括UME消退、复发、中央黄斑厚度改变、视力改善和不良反应。两位审稿人独立筛选和提取数据，并评估研究质量和偏倚风险。采用随机效应模型对比例进行meta分析。本研究已在PROSPERO注册（CRD42024528004）。结果：7项研究共纳入187名参与者（236只眼睛）。所有研究对象均为口服乙酰唑胺。视力改善的总比例为53% (95% CI: 45-60%)，解剖改善的总比例为55% （95% CI: 32-79%）。与安慰剂相比，乙酰唑胺改善视力的可能性高14%，但没有统计学意义（RD: 0.14; 95% CI: -0.04至0.31;p = 0.12）。结论：CAIs，特别是口服乙酰唑胺，为治疗UME提供了一种潜在的替代方案，特别是对类固醇难治性或对类固醇有反应的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Retina-The Journal of Retinal and Vitreous Diseases 医学-眼科学

CiteScore

5.70

自引率

9.10%

发文量

554

审稿时长

3-6 weeks

期刊介绍： RETINA® focuses exclusively on the growing specialty of vitreoretinal disorders. The Journal provides current information on diagnostic and therapeutic techniques. Its highly specialized and informative, peer-reviewed articles are easily applicable to clinical practice. In addition to regular reports from clinical and basic science investigators, RETINA® publishes special features including periodic review articles on pertinent topics, special articles dealing with surgical and other therapeutic techniques, and abstract cards. Issues are abundantly illustrated in vivid full color. Published 12 times per year, RETINA® is truly a “must have” publication for anyone connected to this field.