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Purpose To identify factors associated with best-corrected visual acuity (BCVA) presentation and two-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 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 two-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 two years, eyes better than 20/50 and 20/50 or worse at baseline improved, on average, by 1 letter (p=0.52) and 10 letters (p<0.001) respectively. Both treatment groups and all sites of uveitis improved similarly. Factors associated with improved BCVA included resolution of active AC cells, 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.

Correspondence 329(3), we still think that our case is compatible with clear cell papulosis.The main difference between our case and the previous cases is the location of the lesions, as we have already described in our article (3). The previous cases of clear cell papulosis occurred most commonly on the lower abdomen and usually along the milk line (1,2), but our case occurred on the lumbar area and buttocks (3). However, not all of the previously described lesions occurred exactly along the milk line, and we think the location of the lesion is not a diagnostic criteria. You mentioned that in previous cases the lesions tended to increase in number gradually the first 2 to 3 years after birth, but our case increased within 1 year after birth. However, this is not a significantly different point.Histopathologically, you pointed out that in our case the nuclei of the clear cells appear to be eccentric and about same size and the same degree of basophilia as the neighboring keratinocytes, suggesting basal melanocytes. Although some clear cells had these features, the clear cells in our case usually had centrally located nuclei, as shown in Fig. 3 (electron microscopy finding) in our article (3). Furthermore, the main histologic finding of clear cell papulosis is that the clear cells in the epidermis are larger than the adjacent epidermal cells and are round or oval, with abundant clear cytoplasm, as described in previous cases (2). Our case also had these histopathologic findings. The clear cells in our case were negatively stained by PAS. We did not perform any more stains to confirn this result because the clear cells in original cases were stained variably by several mucin stains and not all clear cells were positive (2). After we received your letter we performed a PAS stain again and did several other mucin stains. Some of the clear cells were positively stained by PAS, alcian blue, and colloidal iron but were negatively stained by mucicannine. If you want to see the photos of these stains, we will be happy to send them to you.You suggested that the clear cells in our case are melanocytes or a hybrid of melanocytes and epithelial cells. We think our positive immunohistochemical stainings for AEl , CEA, and EMA, and negative stainings for S-100 and Fontana-Masson stain can exclude the possibility of melanocytes, and we doubt the existence of a hybrid of melanocytes and epithelial cells.In conclusion, we think the diagnostic findings of our case are multiple white papules clinically, and histopathologically, multiple clear cells in the epidermis which are larger than the adjacent epidermal cells and have abundant clear cytoplasm. These cells stained with the epithelial immunohistochemical markers, AE1, CEA, and EMA. REFERENCES1. Kuo T, Chan HL, Hseuh S. Clear cell papulosis of the skin: a new entity with histogenetic implications €or cutaneous Paget's disease. Am J Surg Pathol 1987;11:827-834.2. Kuo T, Huang C, Chan L, Yang L, Chen M. Clear cell papulosis: report of three cases of a newly recognized disease.

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