Incidence of visual improvement in uveitis cases with visual impairment caused by macular edema

Marc H. Levin, Maxwell Pistilli, Ebenezer Daniel, Sapna S. Gangaputra, Robert B. Nussenblatt, James T. Rosenbaum, Eric B. Suhler, Jennifer E. Thorne, C. Stephen Foster, Douglas A. Jabs, Grace A. Levy-Clarke, John H. Kempen

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36 Scopus citations

Abstract

Purpose Among cases of visually significant uveitic macular edema (ME), to estimate the incidence of visual improvement and identify predictive factors. Design Retrospective cohort study. Participants Eyes with uveitis, seen at 5 academic ocular inflammation centers in the United States, for which ME was documented to be currently present and the principal cause of reduced visual acuity (<20/40). Methods Data were obtained by standardized chart review. Main Outcome Measures Decrease of ≥0.2 base 10 logarithm of visual acuity decimal fraction-equivalent; risk factors for such visual improvement. Results We identified 1510 eyes (of 1077 patients) with visual impairment to a level <20/40 attributed to ME. Most patients were female (67%) and white (76%), and had bilateral uveitis (82%). The estimated 6-month incidence of ≥2 lines of visual acuity improvement in affected eyes was 52% (95% confidence interval [CI], 49%-55%). Vision reduced by ME was more likely to improve by 2 lines in eyes initially with poor visual acuity (≤20/200; adjusted hazard ratio [HR] 1.5; 95% CI, 1.3-1.7), active uveitis (HR, 1.3; 95% CI, 1.1-1.5), and anterior uveitis as opposed to intermediate (HR, 1.2), posterior (HR, 1.3), or panuveitis (HR, 1.4; overall P = 0.02). During follow-up, reductions in anterior chamber or vitreous cellular activity or in vitreous haze each led to significant improvements in visual outcome (P < 0.001 for each). Conversely, snowbanking (HR, 0.7; 95% CI, 0.4-0.99), posterior synechiae (HR, 0.8; 95% CI, 0.6-0.9), and hypotony (HR, 0.2; 95% CI, 0.06-0.5) each were associated with lower incidence of visual improvement with respect to eyes lacking each of these attributes at a given visit. Conclusions These results suggest that many, but not all, patients with ME causing low vision in a tertiary care setting will enjoy meaningful visual recovery in response to treatment. Evidence of significant ocular damage from inflammation (posterior synechiae and hypotony) portends a lower incidence of visual recovery. Better control of anterior chamber or vitreous activity is associated with a greater incidence of visual improvement, supporting an aggressive anti-inflammatory treatment approach for ME cases with active inflammation.

Original languageEnglish (US)
Pages (from-to)588-595.e1
JournalOphthalmology
Volume121
Issue number2
DOIs
StatePublished - Feb 2014

ASJC Scopus subject areas

  • Ophthalmology

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    Levin, M. H., Pistilli, M., Daniel, E., Gangaputra, S. S., Nussenblatt, R. B., Rosenbaum, J. T., Suhler, E. B., Thorne, J. E., Foster, C. S., Jabs, D. A., Levy-Clarke, G. A., & Kempen, J. H. (2014). Incidence of visual improvement in uveitis cases with visual impairment caused by macular edema. Ophthalmology, 121(2), 588-595.e1. https://doi.org/10.1016/j.ophtha.2013.09.023