Seven-Year Outcomes of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial and Follow-up Study Results

Abstract

Purpose: To evaluate the long-term outcomes of uveitic macular edema (ME).

Design: Longitudinal follow-up of a cohort of participants in a randomized clinical trial.

Participants: A total of 248 eyes of 177 participants with uveitic ME enrolled in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study.

Methods: OCT measurements, taken at baseline and annually, were graded by reading center graders masked to clinical data. Macular edema was defined as a center macular thickness (CMT) ≥240 μm on time-domain OCT or time-domain OCT equivalent. Resolution of ME was defined as normalization of macular thickness on OCT. Relapse of ME was defined as increase in macular thickness to ≥240 μm in an eye that previously had resolution. Visual acuity was measured at each visit with logarithmic visual acuity charts.

Main outcome measures: Resolution and relapse of ME. Visual acuity.

Results: Among 227 eyes with ME followed ≥1 year, the cumulative percent of eyes with ME resolving at any point during 7 years was 94% (95% confidence interval [CI], 89-97). Epiretinal membranes on OCT were associated with a lower likelihood of ME resolution (hazard ratio [HR], 0.74; 95% CI, 0.55-1.01; P = 0.05). Among 177 eyes with resolved ME, the cumulative percent with relapse within 7 years was 43% (95% CI, 32-51). Eyes in which ME resolved gained a mean of 6.24 letters (95% CI, 4.40-8.09; P < 0.001) compared with eyes that remained free from ME during the 1-year follow-up intervals, whereas eyes in which ME did not resolve experienced no gain in vision (mean change -1.30 letters; 95% CI, -2.70 to 0.09; P = 0.065), and eyes that developed ME during the year (incident or relapsed) experienced a mean loss of -8.65 letters (95% CI, -11.5 to -5.84, P < 0.001).

Conclusions: Given sufficient time and treatment, nearly all uveitic ME resolves, but episodes of relapse were common. Visual acuity results were better among eyes with resolved ME, suggesting that control of inflammation and resolution of ME might be visually relevant treatment targets.

Trial registration: ClinicalTrials.gov NCT00132691.

Keywords: macular edema; uveitis.

Figure 1.

Time to resolution of macular edema for eyes with macular edema in the Multicenter Uveitis Steroid Treatment Trial and Follow-up Study.

Figure 2.

Time to relapse of macular edema for eyes with macular edema that achieved resolution in the Multicenter Uveitis Steroid Treatment Trial and Follow-up Study.

Figure 3.

Visual acuity over time among participants with macular edema (ME) stratified by current (time-varying) macular edema status as either absent (green, solid line) or present (orange, dotted line). Macular edema after the initial detection could be either persistent or relapsed. The diamond on the Y-axis denotes median visual acuity at the time of macular edema detection for the entire cohort with macular edema (65 letters; Snellen equivalent 20/50).

Figure 4.

Change in visual acuity (in logarithmic acuity chart letters) stratified by the pattern of macular edema (ME) status during the 1-year follow-up intervals over the course of 7 years. The pattern of macular edema status for each eye during each interval was classified as stable without macular edema (no macular edema at the beginning or end of the interval), resolved (macular edema resolved during the interval), new-onset (eye developed macular edema during the interval, either as incident or relapsed), and non-resolved (macular edema present at the beginning and end of the interval).