H Nida Sen1, Francis M Abreu2, Thomas A Louis2, Elizabeth A Sugar3, Michael M Altaweel4, Susan G Elner5, Janet T Holbrook6, Douglas A Jabs7, Rosa Y Kim8, John H Kempen9. 1. National Eye Institute, National Institutes of Health, Bethesda, Maryland. Electronic address: senh@nei.nih.gov. 2. Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. 3. Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. 4. Department of Ophthalmology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 5. Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan. 6. Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. 7. Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Departments of Ophthalmology and Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 8. Retina Consultants of Houston, Houston, Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; and the Department of Ophthalmology, Weill Cornell Medical College, New York, New York. 9. Department of Ophthalmology and the Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Abstract
PURPOSE: To assess the visual outcomes of cataract surgery in eyes that received fluocinolone acetonide implant or systemic therapy with oral corticosteroids and immunosuppression during the Multicenter Uveitis Steroid Treatment (MUST) Trial. DESIGN: Nested prospective cohort study of patients enrolled in a randomized clinical trial. PARTICIPANTS: Patients that underwent cataract surgery during the first 2 years of follow-up in the MUST Trial. METHODS: Visual outcomes of cataract surgery were evaluated 3, 6, and 9 months after surgery using logarithmic visual acuity charts. Change in visual acuity over time was assessed using a mixed-effects model. MAIN OUTCOME MEASURES: Best-corrected visual acuity. RESULTS: After excluding eyes that underwent cataract surgery simultaneously with implant surgery, among the 479 eyes in the MUST Trial, 117 eyes (28 eyes in the systemic, 89 in the implant group) in 82 patients underwentcataract surgery during the first 2 years of follow-up. Overall, visual acuity increased by 23 letters from the preoperative visit to the 3-month visit (95% confidence interval [CI], 17-29 letters; P < 0.001) and was stable through 9 months of follow-up. Eyes presumed to have a more severe cataract, as measured by inability to grade vitreous haze, gained an additional 42 letters (95% CI, 34-56 letters; P < 0.001) beyond the 13-letter gain in eyes that had gradable vitreous haze before surgery (95% CI, 9-18 letters; P < 0.001) 3 months after surgery, making up for an initial difference of -45 letters at the preoperative visit (95% CI, -56 to -34 letters; P < 0.001). Black race, longer time from uveitis onset, and hypotony were associated with worse preoperative visual acuity (P < 0.05), but did not affect postsurgical recovery (P > 0.05, test of interaction). After adjusting for other risk factors, there was no significant difference in the improvement in visual acuity between the 2 treatment groups (implant vs. systemic therapy, 2 letters; 95% CI, -10 to 15 letters; P = 0.70). CONCLUSIONS:Cataract surgery resulted in substantial, sustained, and similar visual acuity improvement in the eyes of patients with uveitis treated with the fluocinolone acetonide implant or standard systemic therapy. Published by Elsevier Inc.
RCT Entities:
PURPOSE: To assess the visual outcomes of cataract surgery in eyes that received fluocinolone acetonide implant or systemic therapy with oral corticosteroids and immunosuppression during the Multicenter UveitisSteroid Treatment (MUST) Trial. DESIGN: Nested prospective cohort study of patients enrolled in a randomized clinical trial. PARTICIPANTS: Patients that underwent cataract surgery during the first 2 years of follow-up in the MUST Trial. METHODS: Visual outcomes of cataract surgery were evaluated 3, 6, and 9 months after surgery using logarithmic visual acuity charts. Change in visual acuity over time was assessed using a mixed-effects model. MAIN OUTCOME MEASURES: Best-corrected visual acuity. RESULTS: After excluding eyes that underwent cataract surgery simultaneously with implant surgery, among the 479 eyes in the MUST Trial, 117 eyes (28 eyes in the systemic, 89 in the implant group) in 82 patients underwent cataract surgery during the first 2 years of follow-up. Overall, visual acuity increased by 23 letters from the preoperative visit to the 3-month visit (95% confidence interval [CI], 17-29 letters; P < 0.001) and was stable through 9 months of follow-up. Eyes presumed to have a more severe cataract, as measured by inability to grade vitreous haze, gained an additional 42 letters (95% CI, 34-56 letters; P < 0.001) beyond the 13-letter gain in eyes that had gradable vitreous haze before surgery (95% CI, 9-18 letters; P < 0.001) 3 months after surgery, making up for an initial difference of -45 letters at the preoperative visit (95% CI, -56 to -34 letters; P < 0.001). Black race, longer time from uveitis onset, and hypotony were associated with worse preoperative visual acuity (P < 0.05), but did not affect postsurgical recovery (P > 0.05, test of interaction). After adjusting for other risk factors, there was no significant difference in the improvement in visual acuity between the 2 treatment groups (implant vs. systemic therapy, 2 letters; 95% CI, -10 to 15 letters; P = 0.70). CONCLUSIONS:Cataract surgery resulted in substantial, sustained, and similar visual acuity improvement in the eyes of patients with uveitis treated with the fluocinolone acetonide implant or standard systemic therapy. Published by Elsevier Inc.
Authors: H Nida Sen; Lea T Drye; Debra A Goldstein; Theresa A Larson; Pauline T Merrill; Peter R Pavan; John D Sheppard; Alyce Burke; Sunil K Srivastava; Douglas A Jabs Journal: Ocul Immunol Inflamm Date: 2012-04 Impact factor: 3.070
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