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

Multicenter Uveitis Steroid Treatment Trial Research Group

Research output: Contribution to journalArticle

38 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)2351-2359
Number of pages9
JournalOphthalmology
Volume122
Issue number11
DOIs
StatePublished - Nov 1 2015
Externally publishedYes

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Macular Edema
Uveitis
Steroids
Visual Acuity
Optical Coherence Tomography
Fluocinolone Acetonide
Therapeutics
Fluorescein Angiography
Group Psychotherapy
Random Allocation
Fluorescein
Immunosuppression
Retina
Edema
Adrenal Cortex Hormones
Outcome Assessment (Health Care)
Injections

ASJC Scopus subject areas

  • Ophthalmology

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Outcome of Treatment of Uveitic Macular Edema : the Multicenter Uveitis Steroid Treatment Trial 2-Year Results. / Multicenter Uveitis Steroid Treatment Trial Research Group.

In: Ophthalmology, Vol. 122, No. 11, 01.11.2015, p. 2351-2359.

Research output: Contribution to journalArticle

Multicenter Uveitis Steroid Treatment Trial Research Group. / Outcome of Treatment of Uveitic Macular Edema : the Multicenter Uveitis Steroid Treatment Trial 2-Year Results. In: Ophthalmology. 2015 ; Vol. 122, No. 11. pp. 2351-2359.
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title = "Outcome of Treatment of Uveitic Macular Edema: the Multicenter Uveitis Steroid Treatment Trial 2-Year Results",
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.",
author = "{Multicenter Uveitis Steroid Treatment Trial Research Group} and Oren Tomkins-Netzer and Susan Lightman and Lea Drye and John Kempen and Holland, {Gary N.} and Rao, {Narsing A.} and Stawell, {Richard J.} and Albert Vitale and Jabs, {Douglas A.} and Jaffe, {G. J.} and B. Branchaud and P. Hahn and L. Koreen and Lad, {E. N.} and Phoebe Lin and Martel, {J. N.} and Serrano, {N. S.} and C. Skalak and L. Vajzovic and C. Baer and J. Bryant and S. Chavala and M. Cusick and S. Day and P. Dayani and J. Ehlers and M. Kesen and A. Lee and A. Melamud and Qureshi, {J. A.} and Scott, {A. W.} and See, {R. F.} and Shuler, {R. K.} and M. Wood and S. Yeh and A. Fernandes and D. Gibbs and D. Leef and Martin, {D. F.} and S. Srivastava and Dunn, {J. P.} and H. Begum and J. Boring and Brotherson, {K. L.} and B. Burkholder and Butler, {N. J.} and D. Cain and Cook, {M. A.} and D. Emmert and Rosenbaum, {James (Jim)}",
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TY - JOUR

T1 - Outcome of Treatment of Uveitic Macular Edema

T2 - the Multicenter Uveitis Steroid Treatment Trial 2-Year Results

AU - Multicenter Uveitis Steroid Treatment Trial Research Group

AU - Tomkins-Netzer, Oren

AU - Lightman, Susan

AU - Drye, Lea

AU - Kempen, John

AU - Holland, Gary N.

AU - Rao, Narsing A.

AU - Stawell, Richard J.

AU - Vitale, Albert

AU - Jabs, Douglas A.

AU - Jaffe, G. J.

AU - Branchaud, B.

AU - Hahn, P.

AU - Koreen, L.

AU - Lad, E. N.

AU - Lin, Phoebe

AU - Martel, J. N.

AU - Serrano, N. S.

AU - Skalak, C.

AU - Vajzovic, L.

AU - Baer, C.

AU - Bryant, J.

AU - Chavala, S.

AU - Cusick, M.

AU - Day, S.

AU - Dayani, P.

AU - Ehlers, J.

AU - Kesen, M.

AU - Lee, A.

AU - Melamud, A.

AU - Qureshi, J. A.

AU - Scott, A. W.

AU - See, R. F.

AU - Shuler, R. K.

AU - Wood, M.

AU - Yeh, S.

AU - Fernandes, A.

AU - Gibbs, D.

AU - Leef, D.

AU - Martin, D. F.

AU - Srivastava, S.

AU - Dunn, J. P.

AU - Begum, H.

AU - Boring, J.

AU - Brotherson, K. L.

AU - Burkholder, B.

AU - Butler, N. J.

AU - Cain, D.

AU - Cook, M. A.

AU - Emmert, D.

AU - Rosenbaum, James (Jim)

PY - 2015/11/1

Y1 - 2015/11/1

N2 - 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.

AB - 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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