John H Kempen1, Mark L Van Natta2, Michael M Altaweel3, James P Dunn4, Douglas A Jabs5, Susan L Lightman6, Jennifer E Thorne7, Janet T Holbrook2. 1. Ocular Inflammation Service, Department of Ophthalmology/Scheie Eye Institute, The University of Pennsylvania, Philadelphia, Pennsylvania; Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology/Scheie Eye Institute, The University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, The University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: john.kempen@uphs.upenn.edu. 2. Center for Clinical Trials, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 3. Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin. 4. Mid-Atlantic Retina, Philadelphia, Pennsylvania; Wills Eye Hospital, Philadelphia, Pennsylvania. 5. Center for Clinical Trials, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York. 6. University College London Institute of Ophthalmology, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom. 7. Center for Clinical Trials, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract
PURPOSE: To identify factors associated with best-corrected visual acuity (BCVA) presentation and 2-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 at 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 2-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 2 years, eyes better than 20/50 and 20/50 or worse at baseline improved, on average, by 1 letter (P = .52) and 10 letters (P < .001), respectively. Both treatment groups and all sites of uveitis improved similarly. Factors associated with improved BCVA included resolution of active AC cells, resolution 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.
RCT Entities:
PURPOSE: To identify factors associated with best-corrected visual acuity (BCVA) presentation and 2-year outcome in 479 intermediate, posterior, and panuveitic eyes. DESIGN: Cohort study using randomized controlled trial data. METHODS: Multicenter UveitisSteroid Treatment (MUST) Trial masked BCVA measurements at baseline and at 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 2-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 2 years, eyes better than 20/50 and 20/50 or worse at baseline improved, on average, by 1 letter (P = .52) and 10 letters (P < .001), respectively. Both treatment groups and all sites of uveitis improved similarly. Factors associated with improved BCVA included resolution of active AC cells, resolution 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.
Authors: D A Jabs; J T Rosenbaum; C S Foster; G N Holland; G J Jaffe; J S Louie; R B Nussenblatt; E R Stiehm; H Tessler; R N Van Gelder; S M Whitcup; D Yocum Journal: Am J Ophthalmol Date: 2000-10 Impact factor: 5.258
Authors: 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 Journal: Ophthalmology Date: 2013-12-12 Impact factor: 12.079
Authors: Elizabeth A Sugar; Douglas A Jabs; Michael M Altaweel; Sue Lightman; Nisha Acharya; Albert T Vitale; Jennifer E Thorne Journal: Am J Ophthalmol Date: 2011-09-08 Impact factor: 5.258
Authors: Nisha R Acharya; Vivien M Tham; Elizabeth Esterberg; Durga S Borkar; John V Parker; Aleli C Vinoya; Aileen Uchida Journal: JAMA Ophthalmol Date: 2013-11 Impact factor: 7.389
Authors: Marc D de Smet; Simon R J Taylor; Bahram Bodaghi; Elisabetta Miserocchi; Philip I Murray; Uwe Pleyer; Manfred Zierhut; Talin Barisani-Asenbauer; Phuc LeHoang; Sue Lightman Journal: Prog Retin Eye Res Date: 2011-07-22 Impact factor: 21.198
Authors: John H Kempen; Michael M Altaweel; Janet T Holbrook; Douglas A Jabs; Thomas A Louis; Elizabeth A Sugar; Jennifer E Thorne Journal: Ophthalmology Date: 2011-08-15 Impact factor: 12.079
Authors: Anat Galor; William Feuer; John H Kempen; R Oktay Kaçmaz; Teresa L Liesegang; Eric B Suhler; C Stephen Foster; Douglas A Jabs; Grace A Levy-Clarke; Robert B Nussenblatt; James T Rosenbaum; Jennifer E Thorne Journal: Br J Ophthalmol Date: 2010-07 Impact factor: 4.638
Authors: David S Friedman; Janet T Holbrook; Husam Ansari; Judith Alexander; Alyce Burke; Susan B Reed; Joanne Katz; Jennifer E Thorne; Susan L Lightman; John H Kempen Journal: Ophthalmology Date: 2013-04-16 Impact factor: 12.079
Authors: S R Rathinam; John A Gonzales; Radhika Thundikandy; Anuradha Kanakath; S Bala Murugan; R Vedhanayaki; Lyndell L Lim; Eric B Suhler; Hassan A Al-Dhibi; Thuy Doan; Jeremy D Keenan; Maya M Rao; Caleb D Ebert; Hieu H Nguyen; Eric Kim; Travis C Porco; Nisha R Acharya Journal: JAMA Date: 2019-09-10 Impact factor: 56.272
Authors: John H Kempen; Michael M Altaweel; Janet T Holbrook; Elizabeth A Sugar; Jennifer E Thorne; Douglas A Jabs Journal: JAMA Date: 2017-05-16 Impact factor: 56.272
Authors: Caroline L Minkus; Maxwell Pistilli; Kurt A Dreger; Tonetta D Fitzgerald; Abhishek R Payal; Hosne Begum; R Oktay Kaçmaz; Douglas A Jabs; Robert B Nussenblatt; James T Rosenbaum; Grace A Levy-Clarke; H Nida Sen; Eric B Suhler; Jennifer E Thorne; Nirali P Bhatt; C Stephen Foster; Jeanine M Buchanich; John H Kempen Journal: Am J Ophthalmol Date: 2021-03-10 Impact factor: 5.488
Authors: John H Kempen; Mark L Van Natta; David S Friedman; Michael M Altaweel; Husam Ansari; James P Dunn; Susan G Elner; Janet T Holbrook; Lyndell L Lim; Elizabeth A Sugar; Douglas A Jabs Journal: Am J Ophthalmol Date: 2020-07-03 Impact factor: 5.488
Authors: Christopher L Passaglia; Tia Arvaneh; Erin Greenberg; David Richards; Brian Madow Journal: Transl Vis Sci Technol Date: 2018-03-23 Impact factor: 3.283
Authors: Maxwell Pistilli; Marshall M Joffe; Sapna S Gangaputra; Siddharth S Pujari; Douglas A Jabs; Grace A Levy-Clarke; Robert B Nussenblatt; James T Rosenbaum; H Nida Sen; Eric B Suhler; Jennifer E Thorne; Nirali P Bhatt; C Stephen Foster; Hosne Begum; Tonetta D Fitzgerald; Kurt A Dreger; Michael M Altaweel; Janet T Holbrook; John H Kempen Journal: Ocul Immunol Inflamm Date: 2019-12-10 Impact factor: 3.728