Cataract Surgery Outcomes in Uveitis: The Multicenter Uveitis Steroid Treatment Trial

Abstract

Purpose: To assess the visual outcomes of cataract surgery in eyes that received fluocinolone acetonide implant or systemic therapy with oral corticosteroids and immunosuppression during the Multicenter Uveitis Steroid Treatment (MUST) Trial.

Design: Nested prospective cohort study of patients enrolled in a randomized clinical trial.

Participants: Patients that underwent cataract surgery during the first 2 years of follow-up in the MUST Trial.

Methods: Visual outcomes of cataract surgery were evaluated 3, 6, and 9 months after surgery using logarithmic visual acuity charts. Change in visual acuity over time was assessed using a mixed-effects model.

Main outcome measures: Best-corrected visual acuity.

Results: After excluding eyes that underwent cataract surgery simultaneously with implant surgery, among the 479 eyes in the MUST Trial, 117 eyes (28 eyes in the systemic, 89 in the implant group) in 82 patients underwent cataract surgery during the first 2 years of follow-up. Overall, visual acuity increased by 23 letters from the preoperative visit to the 3-month visit (95% confidence interval [CI], 17-29 letters; P < 0.001) and was stable through 9 months of follow-up. Eyes presumed to have a more severe cataract, as measured by inability to grade vitreous haze, gained an additional 42 letters (95% CI, 34-56 letters; P < 0.001) beyond the 13-letter gain in eyes that had gradable vitreous haze before surgery (95% CI, 9-18 letters; P < 0.001) 3 months after surgery, making up for an initial difference of -45 letters at the preoperative visit (95% CI, -56 to -34 letters; P < 0.001). Black race, longer time from uveitis onset, and hypotony were associated with worse preoperative visual acuity (P < 0.05), but did not affect postsurgical recovery (P > 0.05, test of interaction). After adjusting for other risk factors, there was no significant difference in the improvement in visual acuity between the 2 treatment groups (implant vs. systemic therapy, 2 letters; 95% CI, -10 to 15 letters; P = 0.70).

Conclusions: Cataract surgery resulted in substantial, sustained, and similar visual acuity improvement in the eyes of patients with uveitis treated with the fluocinolone acetonide implant or standard systemic therapy.

Figure 1

Flowchart showing the selection of uveitic eyes with cataract surgery during the Multicenter Steroid Treatment Trial for inclusion in analysis. VA = visual acuity.

Figure 2

Mean visual acuity over time for eyes with cataract surgery during the Multicenter Steroid Treatment Trial stratified by treatment (implant [grey] vs. systemic [black] therapy). The 95% confidence intervals are included for each treatment group at each interval.