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

Abstract

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.

Long-term visual and systemic prognoses of 83 cases of biopsy-proven sarcoid uveitis

“…This was recently reported in the Multicenter Uveitis Steroid Treatment trial. In this study, the authors speculated that, in intermediate, posterior and panuveitic eyes, successful control of inflammation tended to be associated with visual improvement; in contrast, the persistence or incidence of vitreous haze was associated with a worsening condition 19. In contrast to Lobo et al ,11 we did not identify additional factors associated with outcome, such as older age, African ethnicity or multifocal choroiditis.…”

Doyne lecture 2016: intraocular health and the many faces of inflammation

“…30,31 The health-care burden is significant, where noninfectious uveitis accounts for substantial medical, social, and workload costs in the United Stated of America and aligns with data that persistent disease gives rise to considerable ocular and systemic morbidity. 24,[32][33][34] The clinical phenotype of non-infectious intraocular inflammation is replicated in experimental animal models that are driven by immune responses to self-antigen. 35 The animal models, such as experimental autoimmune uveoretinitis (EAU), support a role for autoimmunity with clinical-pathological features bearing remarkable similarity to man.…”

Intermediate uveitis associated with MS

“…For example, the Multicenter Uveitis Steroid Trial found that patients with IU had a relatively good prognosis, except when macular thickening and edema were detected on optical coherence tomography (OCT) scans combined with active inflammation ( figure 3C ). 28 Moreover, a retrospective case review at a tertiary center found that 22.5% of patients with IU did not require treatment, and 60% had relatively preserved visual acuity after 10 years of follow-up. 29 Hence, the aim of management is to treat sight-threatening features (not uncomplicated or asymptomatic IU) such as glaucoma, cataract, epiretinal membrane, optic disc edema, retinal vasculitis, and retinal detachment.…”