Elsevier

American Journal of Ophthalmology

Volume 160, Issue 6, December 2015, Pages 1133-1141.e9
American Journal of Ophthalmology

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

https://doi.org/10.1016/j.ajo.2015.09.017Get rights and content

Purpose

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

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.

Section snippets

Methods

The MUST Trial—a comparative effectiveness trial comparing fluocinolone acetonide 0.59 mg implant therapy vs systemic therapy with corticosteroids supplemented in most cases with immunosuppression—randomized subjects having active or recently active (within 60 days) intermediate uveitis, posterior uveitis, or panuveitis to the alternative treatments. The MUST Trial (ClinicalTrials.gov Identifier: NCT00132691) was approved by governing institutional review boards at all participating clinical

Results

Among the 479 uveitic eyes of 255 patients enrolled in the MUST Trial, 475 eyes of 254 patients had complete visual acuity information at baseline and were assessed for the presenting visual acuity analyses. Characteristics of this population have been reported previously.7, 9 Four hundred twenty-nine eyes of 231 patients had complete visual acuity at the 2-year follow-up visit (excluding 2 eyes with no light perception at baseline, which could not have changed), and were used in the incidence

Discussion

Our results demonstrate in a detailed fashion that most uveitic eyes of participants in the MUST Trial had favorable visual outcomes, suggesting that severe cases of uveitis for which systemic corticosteroid therapy is indicated have a generally favorable prognosis under best practices systemic10 or implant11, 12 therapy in a subspecialty setting. Many more of the eyes initially 20/50 or worse improved than worsened, especially eyes with baseline BCVA of 20/200 or worse. The latter eyes often

Dr John H. Kempen is Professor of Ophthalmology and Epidemiology at the University of Pennsylvania Perelman School of Medicine. His research evaluates treatment for ocular inflammatory and infectious diseases. He is Chairman of the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study and Vice-Chairman of the Multicenter Uveitis Steroid Treatment (MUST) Trial Network. He is President and Co-Founder of the eyecare organization Sight for Souls, developing self-sustaining

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  • Cited by (0)

    Dr John H. Kempen is Professor of Ophthalmology and Epidemiology at the University of Pennsylvania Perelman School of Medicine. His research evaluates treatment for ocular inflammatory and infectious diseases. He is Chairman of the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study and Vice-Chairman of the Multicenter Uveitis Steroid Treatment (MUST) Trial Network. He is President and Co-Founder of the eyecare organization Sight for Souls, developing self-sustaining comprehensive eye institutes in less-developed countries.

    Mark L. Van Natta is an associate scientist in the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health. He received a Masters of Health Science in Biostatistics from the School in 1987. He has worked at the Johns Hopkins Center for Clinical Trials since 1985 and was the director of the Coordinating Center for the National Eye Institute-sponsored Studies of Ocular Complications of AIDS from 2013–2015.

    Supplemental Material available at AJO.com.

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