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Randomized Controlled Trial
. 2015 Dec;160(6):1133-1141.e9.
doi: 10.1016/j.ajo.2015.09.017. Epub 2015 Sep 18.

Factors Predicting Visual Acuity Outcome in Intermediate, Posterior, and Panuveitis: The Multicenter Uveitis Steroid Treatment (MUST) Trial

John H Kempen  1 , Mark L Van Natta  2 , Michael M Altaweel  3 , James P Dunn  4 , Douglas A Jabs  5 , Susan L Lightman  6 , Jennifer E Thorne  7 , Janet T Holbrook  2 ; Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group
Collaborators, Affiliations
Randomized Controlled Trial

Factors Predicting Visual Acuity Outcome in Intermediate, Posterior, and Panuveitis: The Multicenter Uveitis Steroid Treatment (MUST) Trial

John H Kempen et al. Am J Ophthalmol. 2015 Dec.

Abstract

Purpose: To identify factors associated with best-corrected visual acuity (BCVA) presentation and 2-year outcome in 479 intermediate, posterior, and panuveitic eyes.

Design: Cohort study using randomized controlled trial data.

Methods: Multicenter Uveitis Steroid Treatment (MUST) Trial masked BCVA measurements at baseline and at 2 years follow-up used gold-standard methods. Twenty-three clinical centers documented characteristics per protocol, which were evaluated as potential predictive factors for baseline BCVA and 2-year change in BCVA.

Results: Baseline factors significantly associated with reduced BCVA included age ≥50 vs <50 years; posterior vs intermediate uveitis; uveitis duration >10 vs <6 years; anterior chamber (AC) flare >grade 0; cataract; macular thickening; and exudative retinal detachment. Over 2 years, eyes better than 20/50 and 20/50 or worse at baseline improved, on average, by 1 letter (P = .52) and 10 letters (P < .001), respectively. Both treatment groups and all sites of uveitis improved similarly. Factors associated with improved BCVA included resolution of active AC cells, resolution of macular thickening, and cataract surgery in an initially cataractous eye. Factors associated with worsening BCVA included longer duration of uveitis (6-10 or >10 vs <6 years), incident AC flare, cataract at both baseline and follow-up, pseudophakia at baseline, persistence or incidence of vitreous haze, and incidence of macular thickening.

Conclusions: Intermediate, posterior, and panuveitis have a similarly favorable prognosis with both systemic and fluocinolone acetonide implant treatment. Eyes with more prolonged/severe inflammatory damage and/or inflammatory findings initially or during follow-up have a worse visual acuity prognosis. The results indicate the value of implementing best practices in managing inflammation.

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Conflict of interest statement

Disclosure

Dr. Dunn report no relationships that might be perceived as conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart indicating inclusion of uveitic eyes from Multicenter Uveitis Steroid Treatment (MUST) Trial participants in the baseline and longitudinal visual acuity analyses.
Figure 2
Figure 2
Distribution of best-corrected visual acuity at the baseline visit, uveitic eyes of participants in the Multicenter Uveitis Steroid Treatment (MUST) Trial.
Figure 3
Figure 3
Change in visual acuity between baseline and two years, by baseline visual acuity status, uveitic eyes of participants in the Multicenter Uveitis Steroid Treatment (MUST) Trial. Floor and Ceiling lines are given indicating LP (Light Perception Only)/HM (Hand Movements only)/CF (Counting Fingers only) and 20/10 best-corrected visual acuity. A lowess curve demonstrates the average change across a range of baseline Snellen-equivalent visual acuity scores.
See this image and copyright information in PMC

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