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Outcome of Treatment of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial 2-Year Results.

Publication ,  Journal Article
Tomkins-Netzer, O; Lightman, S; Drye, L; Kempen, J; Holland, GN; Rao, NA; Stawell, RJ; Vitale, A; Jabs, DA ...
Published in: Ophthalmology
November 2015

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.

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Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

November 2015

Volume

122

Issue

11

Start / End Page

2351 / 2359

Location

United States

Related Subject Headings

  • Visual Acuity
  • Uveitis
  • Treatment Outcome
  • Tomography, Optical Coherence
  • Prospective Studies
  • Prednisolone
  • Ophthalmology & Optometry
  • Middle Aged
  • Male
  • Macular Edema
 

Citation

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Tomkins-Netzer, O., Lightman, S., Drye, L., Kempen, J., Holland, G. N., Rao, N. A., … Multicenter Uveitis Steroid Treatment Trial Research Group. (2015). Outcome of Treatment of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial 2-Year Results. Ophthalmology, 122(11), 2351–2359. https://doi.org/10.1016/j.ophtha.2015.07.036
Tomkins-Netzer, Oren, Susan Lightman, Lea Drye, John Kempen, Gary N. Holland, Narsing A. Rao, Richard J. Stawell, Albert Vitale, Douglas A. Jabs, and Multicenter Uveitis Steroid Treatment Trial Research Group. “Outcome of Treatment of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial 2-Year Results.Ophthalmology 122, no. 11 (November 2015): 2351–59. https://doi.org/10.1016/j.ophtha.2015.07.036.
Tomkins-Netzer O, Lightman S, Drye L, Kempen J, Holland GN, Rao NA, et al. Outcome of Treatment of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial 2-Year Results. Ophthalmology. 2015 Nov;122(11):2351–9.
Tomkins-Netzer, Oren, et al. “Outcome of Treatment of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial 2-Year Results.Ophthalmology, vol. 122, no. 11, Nov. 2015, pp. 2351–59. Pubmed, doi:10.1016/j.ophtha.2015.07.036.
Tomkins-Netzer O, Lightman S, Drye L, Kempen J, Holland GN, Rao NA, Stawell RJ, Vitale A, Jabs DA, Multicenter Uveitis Steroid Treatment Trial Research Group. Outcome of Treatment of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial 2-Year Results. Ophthalmology. 2015 Nov;122(11):2351–2359.
Journal cover image

Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

November 2015

Volume

122

Issue

11

Start / End Page

2351 / 2359

Location

United States

Related Subject Headings

  • Visual Acuity
  • Uveitis
  • Treatment Outcome
  • Tomography, Optical Coherence
  • Prospective Studies
  • Prednisolone
  • Ophthalmology & Optometry
  • Middle Aged
  • Male
  • Macular Edema