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

Authors

John H. Kempen, Penn Medicine
Mark L. Van Natta, Johns Hopkins Bloomberg School of Public Health
Michael M. Altaweel, University of Wisconsin-Madison
James P. Dunn, Mid Atlantic Retina
Douglas A. Jabs, Johns Hopkins Bloomberg School of Public Health
Susan L. Lightman, University College London
Jennifer E. Thorne, Johns Hopkins Bloomberg School of Public Health
Janet T. Holbrook, Johns Hopkins Bloomberg School of Public Health
Glenn J. Jaffe
Brenda Branchaud
Paul Hahn
Larry Koreen

Document Type

Journal Article

Publication Date

1-1-2015

Journal

American Journal of Ophthalmology

Volume

160

Issue

6

DOI

10.1016/j.ajo.2015.09.017

Abstract

© 2015 Elsevier Inc. 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.

APA Citation

Kempen, J., Van Natta, M., Altaweel, M., Dunn, J., Jabs, D., Lightman, S., Thorne, J., Holbrook, J., Jaffe, G., Branchaud, B., Hahn, P., & Koreen, L. (2015). Factors Predicting Visual Acuity Outcome in Intermediate, Posterior, and Panuveitis: The Multicenter Uveitis Steroid Treatment (MUST) Trial. American Journal of Ophthalmology, 160 (6). http://dx.doi.org/10.1016/j.ajo.2015.09.017