uveitis, CRVO and Macular Edema

[Mike Bartolatz]

an unusual case of early age onset of Central Retinal Vein occulsion, Macular Edema and Uveitis.

the following is a discussion by C Stephen Foster MD of the Ocular immunology and Uveitis Foundation at his site http://www.uveitis.org in the ASK DR FOSTER FORUM on what to look for as a cause:
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You mention 3 issues: vein occlusion; uveitis (almost as an aside); and macular edema. You are 46. Vein occlusion is not common in someone who is 46 unless there is some underlying predisposition to that. Some such predispositions are modifiable. Given the fact that you've had it in both eyes, maximal efforts should be made to discern any underlying modifiable predisposition, so that efforts can be made to protect you against it happening yet again. All classes of anti-cardiolipin antibody, lupus anticoagulant, protein S and C and all other clotting factors (Leiden factor five, etc) must be aggressively analyzed, as should be homocysteine levels and C1q binding and Raji cell assays for circulating immune complexes. If you are immunologically abnormal, making, for example, immune complexes or abnormal antibodies, then immunomodulatory therapy is appropriate.
Macular edema therapy will constantly fail if uveitis is present or is recurrent. Uveitis MUST be in constant remission if therapy for macular edema is to have ANY chance of success. Once uveitis is no longer an issue, then therapy involving topical and oral non-steroidal agents, regional and intraocular steroid injections, intraocular Lucentis or Avastin, systemic Diamox and intramuscular Sandostatin, as well as hyperbaric oxygen are the other strategies we employ in our care of patients with recurrent macular edema.

Stephen Foster