Randomized Controlled Trial

. 2023 Oct:254:210-220.

doi: 10.1016/j.ajo.2023.06.023. Epub 2023 Jul 3.

Cataract Surgery in Patients With Uveitis Treated With Systemic Therapy in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study: Risk Factors and Outcomes

Affiliations

¹ From the Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (D.A.J., E.A.S., A.E.B., J.T.H.), Baltimore, Maryland, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine (D.A.J.), Baltimore, Maryland, USA. Electronic address: djabs@jhmi.edu.
² From the Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (D.A.J., E.A.S., A.E.B., J.T.H.), Baltimore, Maryland, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health (E.A.S.), Baltimore, Maryland, USA.
³ From the Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (D.A.J., E.A.S., A.E.B., J.T.H.), Baltimore, Maryland, USA.
⁴ School of Medicine and Public Health, Department of Ophthalmology and Reading Center, University of Wisconsin, Madison (M.M.A.), Madison, Wisconsin, USA.
⁵ Wills Eye Hospital, Department of Ophthalmology, Thomas Jefferson University (J.P.D.), Philadelphia, Pennsylvania, USA.
⁶ Vanderbilt Eye Institute, Vanderbilt University School of Medicine (S.G.), Nashville, Tennessee, USA.
⁷ Department of Ophthalmology Harvard Medical School and Massachusetts Eye and Ear Infirmary (J.H.K.), Boston, Massachusetts, USA; MCM Eye Unit, Myung Sung Christian Medical Center General Hospital and Medical School (J.H.K.), Addis Ababa, Ethiopia.
⁸ Department of Ophthalmology, University of Washington School of Medicine (K.L.P.), Seattle, Washington, USA.
⁹ Department of Ophthalmology, University of Melbourne, Royal Victorian Eye and Ear Hospital (R.J.S.), East Melbourne, Victoria, Australia.

PMID: 37406846
PMCID: PMC10528707
DOI: 10.1016/j.ajo.2023.06.023

Randomized Controlled Trial

Cataract Surgery in Patients With Uveitis Treated With Systemic Therapy in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study: Risk Factors and Outcomes

Douglas A Jabs et al. Am J Ophthalmol. 2023 Oct.

. 2023 Oct:254:210-220.

doi: 10.1016/j.ajo.2023.06.023. Epub 2023 Jul 3.

Affiliations

¹ From the Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (D.A.J., E.A.S., A.E.B., J.T.H.), Baltimore, Maryland, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine (D.A.J.), Baltimore, Maryland, USA. Electronic address: djabs@jhmi.edu.
² From the Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (D.A.J., E.A.S., A.E.B., J.T.H.), Baltimore, Maryland, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health (E.A.S.), Baltimore, Maryland, USA.
³ From the Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (D.A.J., E.A.S., A.E.B., J.T.H.), Baltimore, Maryland, USA.
⁴ School of Medicine and Public Health, Department of Ophthalmology and Reading Center, University of Wisconsin, Madison (M.M.A.), Madison, Wisconsin, USA.
⁵ Wills Eye Hospital, Department of Ophthalmology, Thomas Jefferson University (J.P.D.), Philadelphia, Pennsylvania, USA.
⁶ Vanderbilt Eye Institute, Vanderbilt University School of Medicine (S.G.), Nashville, Tennessee, USA.
⁷ Department of Ophthalmology Harvard Medical School and Massachusetts Eye and Ear Infirmary (J.H.K.), Boston, Massachusetts, USA; MCM Eye Unit, Myung Sung Christian Medical Center General Hospital and Medical School (J.H.K.), Addis Ababa, Ethiopia.
⁸ Department of Ophthalmology, University of Washington School of Medicine (K.L.P.), Seattle, Washington, USA.
⁹ Department of Ophthalmology, University of Melbourne, Royal Victorian Eye and Ear Hospital (R.J.S.), East Melbourne, Victoria, Australia.

PMID: 37406846
PMCID: PMC10528707
DOI: 10.1016/j.ajo.2023.06.023

Abstract

Purpose: To evaluate the rate of, risk factors for, and outcomes of cataract surgery in patients with intermediate, posterior, and panuveitides treated with systemic corticosteroids and immunosuppression.

Design: Cohort study of participants from a randomized clinical trial.

Methods: A multicenter clinical trial with extended follow-up comprised the study setting. From the cohort of participants assigned to systemic therapy in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study, 125 phakic eyes of 74 patients with intermediate, posterior, or panuveitides treated with systemic therapy were included. The main outcome measures were cataract surgery and visual acuity after cataract surgery.

Results: The cumulative incidence of cataract surgery was 43% at 7 years of follow-up, and the risk did not plateau. Risk factors for cataract surgery included age >50 years (hazard ratio [HR] 2.86, 95% CI 1.52, 5.42; P = .001), topical corticosteroid use (time-updated HR 3.13, 95% CI 1.42, 6.94; P = .005), glaucoma medication use (HR 2.75, 95% CI 1.38, 5.47; P = .004), and possibly history of anterior chamber inflammation (HR 1.90, 95% CI 0.95, 3.84; P = .07). Median gain in acuity and median best corrected visual acuity 1 year after cataract surgery were 4.8 lines and 20/25, respectively, among 42 eyes undergoing cataract surgery with 1-year follow-up data.

Conclusions: Among patients with intermediate, posterior, and panuveitides, treated with oral corticosteroids and immunosuppression, there is a substantial long-term risk of cataract surgery. Visual acuity outcomes after cataract surgery are generally good.

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Conflict of interest statement

Conflict of interest:

Douglas A. Jabs: none; Elizabeth A. Sugar: none: Alyce E. Burke: none; Michael M. Altaweel: none; James P. Dunn: none; Sapna Gangaputra: MERIT CRO (consultant); John H. Kempen: Gilead Sciences, Inc. (Data and Safety Monitoring Committee); Kathryn L. Pepple: none; Richard Stawell: none. Janet T. Holbrook: none.

Figures

**Figure 1.**
Kaplan-Meier plot of time to cataract surgery among patients with intermediate, posterior, or panuveitides treated with systemic therapy.

**Figure 2.**
Lasagna plot of the visual acuity after cataract surgery for individuals with intermediate, posterior, or panuveitides treated with systemic therapy sorted by preoperative visual acuity.

See this image and copyright information in PMC

Comment in

Cataracts, Corticosteroids, and Canaries in the Coal Mine.
Read RW, Denniston A, Holland GN. Read RW, et al. Am J Ophthalmol. 2023 Oct;254:A4-A6. doi: 10.1016/j.ajo.2023.06.022. Epub 2023 Jun 30. Am J Ophthalmol. 2023. PMID: 37393973 No abstract available.

References

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Cataract Surgery in Patients With Uveitis Treated With Systemic Therapy in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study: Risk Factors and Outcomes

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Cataract Surgery in Patients With Uveitis Treated With Systemic Therapy in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study: Risk Factors and Outcomes

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