Abstract
Purpose To evaluate the 2-year outcomes of uveitic macular edema. Design Longitudinal follow-up of a randomized cohort. Participants At baseline, 148 eyes of 117 patients enrolled in the Multicenter Uveitis Steroid Treatment (MUST) Trial had macular edema, and 134 eyes of 108 patients completed 2-year follow-up. Methods Patients enrolled in the study were randomized to either systemic immunosuppression or intravitreal fluocinolone acetonide implant therapy. Macular edema was defined as thickening of the retina (center point thickness ≥240 μm) on time-domain optical coherence tomography (OCT) of macula. Main Outcome Measures Improvement in macular edema (≥20% reduction in central point thickness on OCT), resolution of macular edema (normalization of thickness on OCT), and best-corrected visual acuity (BCVA). Results Between randomization and 2-years' follow-up, 62% and 25% of eyes in the systemic and implant groups, respectively, received at least 1 supplemental regional corticosteroid injection. By 2-years' follow-up, macular edema improved in 71% of eyes and resolved in 60%. There were no differences between treatment groups in the proportion of eyes with macular edema improving (systemic therapy vs. implant, 65% vs. 77%; P = 0.20) and resolving (52% vs. 68%; P = 0.28), but eyes randomized to implant had more improvement in macular thickness (median decrease of 180 vs. 109 μm in the systemic therapy group; P = 0.04). Eyes with baseline fluorescein angiographic leakage were more likely to improve than those without (76% vs. 58%; P = 0.03). Overall, there was a mean 5-letter (1 line) improvement in BCVA at 2 years. Mean changes in BCVA from baseline at 2 years by macular edema response status were: resolution, +10 letters; improvement without resolution, +10 letters (P = 0.92); little to no change, 6 letters (P = 0.19); and worsening, -16 letters (worsening acuity; P = 0.0003). Conclusions About two thirds of eyes with uveitic macular edema were observed to experience improvement in the edema and visual acuity with implant or systemic treatment. Fluocinolone acetonide implant therapy was associated with a greater quantitative improvement in thickness. Fluorescein angiography leakage was associated with a greater likelihood of improvement in macular edema.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2351-2359 |
| Number of pages | 9 |
| Journal | Ophthalmology |
| Volume | 122 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 1 2015 |
Funding
The author(s) have made the following disclosure(s): S.L.: Grants and personal fees - Allergan. J.K.: Consultant - Alcon, Allergan, Clearside, Can-Fite, Lux Biosciences, Xoma, Sanofi-Pasteur, Roche, Abbvie, Vitae; Employee - University of Pennsylvania; Grants/grants pending - EyeGate, Food and Drug Administration, Lions Club International Foundation, National Eye Institute. G.N.H.: Medical advisory boards - Genentech, Novartis International AG, Santen, Xoma. A.V.: Consultant - Aciont. D.A.J.: Consultant - Santen; Serves on data and safety monitoring committees - Applied Genetic Technologies Corporation and Novartis Pharmaceutical Corporation. All other authors have no conflicts of interest to report. Supported in part by cooperative agreements U10 EY 014655 to the Icahn School of Medicine at Mount Sinai, U10 EY 014660 to the Johns Hopkins University Bloomberg School of Public Health, and U10 EY 014654 to the University of Wisconsin, Madison, from the National Eye Institute, the National Institutes of Health, Bethesda, Maryland.
ASJC Scopus subject areas
- Ophthalmology