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

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