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1. Health- and Vision-Related Quality of Life in a Randomized Controlled Trial Comparing Methotrexate and Mycophenolate Mofetil for Uveitis

Author

Nicole K. Kelly, Aheli Chattopadhyay, S.R. Rathinam, John A. Gonzales, Radhika Thundikandy, Anuradha Kanakath, S. Bala Murugan, R. Vedhanayaki, Dean Cugley, Lyndell L. Lim, Eric B. Suhler, Hassan A. Al-Dhibi, Caleb D. Ebert, Elyse J. Berlinberg, Travis C. Porco, Nisha R. Acharya, A.L. Sivarama Subramanian, G. Jeyakohila, Gracy Evangelin, A.M. Azhagupandi, C.V. Praba, S. Bharati, S. Gomathi, N.J. Nirmaladevi, Mohammed Siddiq, B. Vijayakumar, S.R. Devi, V.R. Saravanan, Upendra Babu, R. Srija, S. Dhanalakshmi, R.R. Sakthimari, P.S. Keerthana, A.M. Mallika, C. Vasanthi, P.B. Mariselvi, P. Pandeeswari, S.M. Sudarvanitha, R. Prema, Prabu Baskaran, S. Madanagopalan, Chokkahalli K. Nagesha, R. Thilagavathi, Chitra Krishnakumari, Irudhaya Raj P, S. Saravanan, Grace Mary, S. Nagarasi, Kiruba Gnansi, Lourdes Arellanes-Garcia, Luz Elena Concha del Rio, Rashel Cheja Kalb, Nancy Fernández, Yoko Burgoa, Hilda Hernández, Roberto Fabela Cuello, Lorenzo Agustín Martínez Garcia, Ricardo Montoya Rodríguez, Maria del Carmen Preciado, Andrea Arreola, Donald Stone, Mohammed Al-Shamrani, Sara Al-Nuwaysir, Abdulrahman Al-Hommadi, Abdullah Al-Omran, Saleh Al-Nasser, Gahram Al-Zahrani, Eman Mashan, Mizher Al-Ghamdi, Ayshah Al-Tuwejri, Debra A. Goldstein, Anna Liza Castro-Malek, Gemma Dela Rosa, Marriner Skelly, Eric Suhler, James Rosenbaum, Phoebe Lin, Sherveen Salek, Kristin Biggee, Amde Shifera, Laura Kopplin, George Mount, Tracy Giles, Susan Nolte, Ann Lundquist, Teresa Liesegang, Albert Romo, Chris Howell, Scott Pickell, Peter Steinkemp, Dawn Ryan, Jordan Barth, Jocelyn Hui, Chiedozie Ukachukwu, Lyndell Lim, Richard Stawell, Robyn Troutbeck, Cecilia Ling, Xavier Fagan, Julian Bosco, Timothy Godfrey, Tanya Pejnovic, Carly D’Sylva, Sutha Sanmugasundram, Tina-Marie van Tonder, Maria Kolic, Nisha Acharya, John Gonzales, Thuy Doan, Sarah Lopez, Maya Rao, Erica Browne, Betty Hom, Mary Lew, Salena Lee, Travis Porco, Thomas Lietman, Jeremy Keenan, Eric Kim, Hieu Nguyen, Caleb Ebert, Elyse Berlinberg, Andrew Hirst, Rachel Weinrib, Maureen G. Maguire, William E. Barlow, Steven Yeh, Albert T. Vitale, Jaqueline J. Glover, Narsing A. Rao, and Donald F. Everett

Subjects
Adult, Male, medicine.medical_specialty, Visual acuity, Health Status, Administration, Oral, Article, law.invention, Uveitis, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Randomized controlled trial, Interquartile range, law, Sickness Impact Profile, Surveys and Questionnaires, Internal medicine, medicine, Clinical endpoint, Humans, Prospective Studies, Enzyme Inhibitors, Vision, Ocular, Aged, 030304 developmental biology, 0303 health sciences, business.industry, Outcome measures, Middle Aged, Mycophenolic Acid, medicine.disease, humanities, Ophthalmology, Methotrexate, Health, Quality of Life, 030221 ophthalmology & optometry, Female, medicine.symptom, business, Immunosuppressive Agents, medicine.drug
Abstract

To evaluate changes in health-related and vision-related quality of life (VRQoL) among patients with noninfectious uveitis who were treated with antimetabolites.Secondary analysis of a randomized controlled trial.Patients with noninfectious uveitis from India, the United States, Australia, Saudi Arabia, and Mexico.From 2013 through 2017, 216 participants were randomized to receive 25 mg weekly oral methotrexate or 1.5 g twice daily oral mycophenolate mofetil. Median changes in quality of life (QoL) were measured using Wilcoxon signed-rank tests, and differences between treatment groups were measured using linear mixed models, adjusting for baseline QoL score, age, gender, and site. Among Indian patients, VRQoL scores from a general scale (the National Eye Institute Visual Function Questionnaire [NEI-VFQ]) and a culturally specific scale (the Indian Visual Function Questionnaire [IND-VFQ]) were compared using Pearson correlation tests.Vision-related QoL (NEI-VFQ and IND-VFQ) and health-related QoL (HRQoL; physical component score [PCS] and mental component score [MCS] of the Medical Outcomes Study 36-Item Short Form Survey [SF-36v2]) were measured at baseline, the primary end point (6 months or treatment failure before 6 months), and the secondary end point (12 months or treatment failure between 6 and 12 months).Among 193 participants who reached the primary end point, VRQoL increased from baseline by a median of 12.0 points (interquartile range [IQR], 1.0-26.1, NEI-VFQ scale), physical HRQoL increased by a median of 3.6 points (IQR, -1.4 to 14.9, PCS SF-36v2), and mental HRQoL increased by a median of 3.0 points (IQR, -3.7 to 11.9, MCS SF-36v2). These improvements in NEI-VFQ, SF-36v2 PCS, and SF-36v2 MCS scores all were significant (P0.01). The linear mixed models showed that QoL did not differ between treatment groups for each QoL assessment (NEI-VFQ, IND-VFQ, PCS SF-36v2, and MCS SF-36v2; P0.05 for all). The NEI-VFQ and IND-VFQ scores for Indian participants were correlated highly at baseline and the primary and secondary end points (correlation coefficients, 0.87, 0.80, and 0.90, respectively).Among patients treated with methotrexate or mycophenolate mofetil for uveitis, VRQoL and HRQoL improved significantly over the course of 1 year and did not differ by treatment allocation. These findings suggest that antimetabolites could improve overall patient well-being and daily functioning.

Published
2021

2. Tolerating Subretinal Fluid in Neovascular Age-Related Macular Degeneration Treated with Ranibizumab Using a Treat-and-Extend Regimen

Author

Robyn H. Guymer, Caroline M. Markey, Ian L. McAllister, Mark C. Gillies, Alex P. Hunyor, Jennifer J. Arnold, Andrew Chang, Adil Syed, Geoffrey Broadhead, Thomas Pham, Thomas Hong, Lily Wong, Meidong Zhu, Shelley Burnett, Nichole Joachim, Wijeyanthy Wijeyakumar, Gabriel Manalang, Cleopatra Mhlanga, Nicole Joachim, Kimperly Spooner, Paul Mitchell, Suriya Foran, Christabel Wilson, Victoria Cossatto, Laskshmi Waniganayke, Vivien Mai, Rabiya Atif, Lakshmi Wa, Sapna Maharaj, David Liong, Christine Matic, Katherine Tran, Sheenal Jas, Danielle Gibbs, Sanj Wickremasinghe, Robyn Guymer, Lyndell Lim, Sukhpal Sandhu, Thanh Nguyen, Dania Qatarneh, Hessom Razavi, Elaine Chong, Matthew Little, Gaurav Bhardwau, Michael Ayres, Michael Chen, Daini Ong, Katarina Creese, Tricia Drew, Carly D'Sylva Parfett, Tanya Pejnovic, Thuy Chau, Sutha Sanmugasundram, Maria Kolic, Elizabeth Glatz, Tina-Marie Tonder, Alan Luckie, Stephen Heery, Timothy Steele, Jennifer Arnold, Bryan Matthews, Julie Croft, Alex Breen, Bronwyn Gabriel, Maegan Anderson, Michelle Dodds, Marcus Dwyer, Bev Brown, Jacinta Dwyer, Ivan Fu, Helen Macauley, James Wong, Rajeev Chalasani, Charmaine Lim, Son Huynh, Timothy Nolan, James Leong, Kit Lau, Swas Kumar, Trang Nguyen, Joseph Bitar, Hannah Ahern, Arooj Ali, Nuria Zamora, Angela Lai, Randa Moussa, Carmen Do, Nitin Verma, Guy Bylsma, Andrew Traill, Beverley Curry, Amy Paprotny, Alfonso Ayesa, Alyse Johns, Zanobia Ujjainwala, Andrew Maver, Derek Chan, John Chang, Hyong Kwon Kang, Gavin Stringfellow, Terence Tan, Helen Cass, Trish Forsyth, Anh Nguyen, Angela Chung, Harriette Ayson, Catherine Severino, Caroline Chahine, Lara Collis, Anita Cristy, Mona Mohmodian, Selina Webb, Muradiya Payir, Mara Garibaldi, Trazia Mekhail, Brendan Vote, Tze'Yo Toh, Nima Pakrou, Jennie Rossetto, Shannon Harris, Rachael Adams, Rachael Groves, Maddie Johns, Kristie Richards, Eliza Jenkins, Natalie Daley, James Baker, Mark Gorbatov, Lavaniya Rajanayagam, Ludmila Jitskaia, Jenny Xie, Anthony Nguyen, Ian McAllister, Fred Chen, Tim Isaacs, Tracey-Anne Dickens, Rachel Matthews, Amelia Jason, Ivy Tang, Gareth Lingham, Holly Brown, Alla Soloshenko, Max Cuypers, Anne McSweeney, Jolly Gilhotra, Shane Durkin, James Muecke, Kerin Haywood, Cathy Brko, Rinty Vincent, Carolyn Luscombe, Alex Hunyor, Christine Younan, Robert Chong, Rohan Merani, Adrian Fung, I-Van Ho, Gerald Liew, Vinnci Lee, Gerald Chan, Sarah Liu, Tharini Ganess, Susanthy Rajasundaran, Maryam Sadat, Godfrey Quin, Stephen Ong, Claire Hooper, Vivien Dihn, Ward Al-Ghurani, Sally Ngai, Maria Choi, Gordana Tisma, Anton Van Heerden, Anthony Hall, Kira Michalova, Natalie Coleman, Allanah Price, Mercy Nguyen, Clodia Hanna, Camille Collins, Elaina Dickeson, Annie Lee, Mela Bilyk, Theresa Lee, John Downie, Naggi Assaad, Leanne Cooper, Catherine Le, Amanda Armanssen, and Zena Khalil

Subjects
medicine.medical_specialty, Visual acuity, genetic structures, Bevacizumab, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Ophthalmology, Medicine, Prospective cohort study, 030304 developmental biology, 0303 health sciences, medicine.diagnostic_test, business.industry, Retrospective cohort study, Macular degeneration, Fluorescein angiography, medicine.disease, 030221 ophthalmology & optometry, medicine.symptom, Ranibizumab, business, medicine.drug
Abstract

Purpose To test the hypothesis that tolerating some subretinal fluid (SRF) in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab using a treat-and-extend (TE intensive arm: SRF intolerant) or resolution of all IRF only (relaxed arm: SRF tolerant except for SRF >200 μm at the foveal center) before extending treatment intervals. A 5-letter noninferiority margin was applied to the primary outcome. Main Outcome Measures Mean change in best-corrected VA (BCVA), and central subfield thickness and number of injections from baseline to month 24. Results Of the 349 participants randomized (intensive arm, n = 174; relaxed arm, n = 175), 279 (79.9%) completed the month 24. The mean change in BCVA from baseline to month 24 was 3.0 letters (standard deviation, 16.3 letters) in the intensive group and 2.6 letters (standard deviation, 16.3 letters) in the relaxed group, demonstrating noninferiority of the relaxed compared with the intensive treatment (P = 0.99). Similar proportions of both groups achieved 20/40 or better VA (53.5% and 56.6%, respectively; P = 0.92) and 20/200 or worse VA (8.7% and 8.1%, respectively; P = 0.52). Participants in the relaxed group received fewer ranibizumab injections over 24 months (mean, 15.8 [standard deviation, 5.9]) than those in the intensive group (mean, 17 [standard deviation, 6.5]; P = 0.001). Significantly more participants in the intensive group never extended beyond 4-week treatment intervals (13.5%) than in the relaxed group (2.8%; P = 0.003), and significantly more participants in the relaxed group extended to and maintained 12-week treatment intervals (29.6%) than the intensive group (15.0%; P = 0.005). Conclusions Patients treated with a ranibizumab T&E protocol who tolerated some SRF achieved VA that is comparable, with fewer injections, with that achieved when treatment aimed to resolve all SRF completely.

Published
2019

3. Dissociations of the Fluocinolone Acetonide Implant: The Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study

Author

Janet T. Holbrook, Elizabeth A. Sugar, Alyce E. Burke, Albert T. Vitale, Jennifer E. Thorne, Janet L. Davis, Douglas A. Jabs, Glenn J. Jaffe, Brenda Branchaud, Paul Hahn, Larry Koreen, Eleonora (Nora) M. Lad, Phoebe Lin, Joseph Nissim Martel, Neha (Shah) Serrano, Cindy Skalak, Lejla Vajzovic, Claxton Baer, Joyce Bryant, Sai Chavala, Michael Cusick, Shelley Day, Pouya Dayani, Justis Ehlers, Muge Kesen, Annie Lee, Alex Melamud, Jawad A. Qureshi, Adrienne Williams Scott, Robert F. See, Robert K. Shuler, Megan Wood, Steven Yeh, Alcides Fernandes, Deborah Gibbs, Donna Leef, Daniel F. Martin, Sunil Srivastava, James P. Dunn, Hosne Begum, Jeff Boring, Kristen L. Brotherson, Bryn Burkholder, Nicholas J. Butler, Dennis Cain, Mary A. Cook, David Emmert, Janis R. Graul, Mark Herring, Ashley Laing, Theresa G. Leung, Michael C. Mahon, Ahmafreza Moradi, Antonia Nwankwo, Trucian L. Ostheimer, Terry Reed, Ellen Arnold, Patricia M. Barnabie, Marie-Lynn Belair, Stephen G. Bolton, Joseph B. Brodine, Diane M. Brown, Lisa M. Brune, Anat Galor, Theresa Gan, Adam Jacobowitz, Meera Kapoor, Sanjay Kedhar, Stephen Kim, Henry A. Leder, Alison G. Livingston, Yavette Morton, Kisten Nolan, George B. Peters, Priscilla Soto, Ricardo Stevenson, Michelle Tarver-Carr, Yue Wang, C. Stephen Foster, Stephen D. Anesi, null Linda Bruner, Olga Ceron, David M. Hinkle, Nancy Persons, Bailey Wentworth, Sarah Acevedo, Fahd Anzaar, Tom Cesca, Angelica Contero, Kayleigh Fitzpatrick, Faith Goronga, Jyothir Johnson, Karina Q. Lebron, Danielle Marvell, Chandra Morgan, Nita Patel, Jennifer Pinto, Sana S. Siddique, Janet Sprague, Taygan Yilmaz, H. Nida Sen, Michael Bono, Denise Cunningham, Darryl Hayes, Dessie Koutsandreas, Robert B. Nussenblatt, Patti R. Sherry, Gregory L. Short, Wendy Smith, Alana Temple, Allison Bamji, Hanna Coleman, Geetaniali Davuluri, Lisa Faia, Chloe Gottlieb, Guy V. Jirawuthiworavong, Julie C. Lew, Richard Mercer, Dominic Obiyor, Cheryl H. Perry, Natalia Potapova, Eric Weichel, Keith J. Wroblewski, Paul A. Latkany, Corinne Coonan, Andrea Honda, Monica Lorenzo-Latkany, Robert Masini, Susan Morell, Angela Nguyen, Jason Badamo, Kenneth M. Boyd, Matthew Enos, Jenny Gallardo, Jacek Jarczynski, Ji Yun Lee, Mirjana McGrosky, Ann Nour, Meredith Sanchez, Kate Steinberg, Richard J. Stawell, Lisa Breayley, Carly D'Sylva, Elizabeth Glatz, Lauren Hodgson, Lyndell Lim, Cecilia Ling, Rachel McIntosh, Julie Morrison (Ewing), Andrew Newton, Sutha Sanmugasundram, Richard Smallwood, Ehud Zamir, Nicola Hunt, Lisa Jones, Ignatios Koukouras, Suzanne Williams, Pauline T. Merrill, Danielle Carns, Len Richine, Denise L. Voskuil-Marre, Kisung Woo, Bruce Gaynes, Christina Giannoulis, Pam Hulvey, Elaine Kernbauer, Heena S. Khan, Sarah J. Levine, Scott Toennessen, Eileen Tonner, Robert C. Wang, Hank Aguado, Sally Arceneaux, Karen Duignan, Gary E. Fish, Nick Hesse, Diana Jaramillo, Michael Mackens, Jean Arnwine, David Callanan, Kimberly Cummings, Keith Gray, Susie Howden, Karin Mutz, Brenda Sanchez, Susan Lightman, Filis Ismetova, Ashley Prytherch, Sophie Seguin-Greenstein, Oren Tomkins, Asat Bar, Kate Edwards, Lavanish Joshi, Jiten Moraji, Ahmed Samy, Timothy Stubbs, Simon Taylor, Hamish Towler, Rebecca Tronnberg, Gary N. Holland, Robert D. Almanzor, Jose Castellanos, Jean Pierre Hubschman, Ann K. Johiro, Alla Kukuyev, Ralph D. Levinson, Colin A. McCannel, Susan S. Ransome, Christine R. Gonzales, Anurag Gupta, Partho S. Kalyani, Michael A. Kapamajian, Peter J. Kappel, Cheryl Arcinue, Janne Chuang, Giulio Barteselli, Glenn Currie, Veronica Mendoza, Debbie Powell, Tom Clark, Denine E. Cochran, William R. Freeman, Joshua Hedaya, Tiara Kemper, Igor Kozak, Jacqueline M. LeMoine, Megan E. Loughran, Luzandra Magana, Francesca Mojana, Victoria Morrison, Vivian Nguyen, Stephen F. Oster, Nisha Acharya, David Clay, Salena Lee, Mary Lew, Todd P. Margolis, Jay Stewart, Ira G. Wong, Debra Brown, Claire M. Khouri, Debra A. Goldstein, Andrea Birnbaum, Andrea Degillio, Gemma De la Rosa, Carmen Ramirez, Evica Simjanowski, Mariner Skelly, Anna L. Castro-Malek, Catherine E. Crooke, Melody Huntley, Katrina Nash, Marcia Niec, Dimitry Pyatetsky, Misel Ramirez, Zuzanna Rozenbajgier, Howard H. Tessler, Thomas A. Albini, Marie Chin, Daniela Castaño, Ariana Elizondo, Macy Ho, Jaclyn L. Kovach, Richard C-S. Lin, Efrem Mandelcorn, Jackie K-D. Nguyen, Aura Pacini, Susan Pineda, David A. Pinto, Jose Rebimbas, Kimberly E. Stepien, Claudia Teran, Susan G. Elner, Hillary Bernard, Linda Fournier, Lindsay Godsey, Linda Goings, Richard Hackel, Moella Hesselgrave, K. Thiran Jayasundera, Robert Prusak, Pamela Titus, Melissa Bergeron, Reneé Blosser, Rebecca Brown, Carrie Chrisman-McClure, Julie R. Gothrup, Stephen J. Saxe, Deanna Sizemore, John H. Kempen, James Berger, Sheri Drossner, Joan C. DuPont, Albert M. Maguire, Janice Petner, Stephanie Engelhard, Tim Hopkins, Dawn McCall, Monique McRay, Daniel Will, Wei Xu, Jonathan Lo, Rebecca Salvo, Elizabeth Windsor, Laurel Weeney, Peter R. Pavan, Ken Albritton, JoAnn Leto, Brian Madow, Lori Mayor, Scott E. Pautler, Wyatt Saxon, Judy Soto, Burton Goldstein, Amy Klukoff, Lucy Lambright, Kim McDonald, Maria Ortiz, Susan Scymanky, Dee Dee Szalay, Narsing Rao, Tamara Davis, Jackie Douglass, Judith Linton, Margaret Padilla, Sylvia Ramos, Alexia Aguirre, Lawrence Chong, Lupe Cisneros, Elizabeth Corona, Dean Eliott, Amani Fawzi, Jesse Garcia, Rahul Khurana, Jennifer Lim, Rachel Mead, Julie H. Tsai, Albert Vitale, Paul S. Bernstein, Bonnie Carlstrom, James Gilman, Sandra Hanseen, Paula Morris, Diana Ramirez, Kimberley Wegner, John D. Sheppard, Brianne Anthony, Amber Casper, Lisa Felix-Kent, Jeanette Fernandez, Tari Johnson, Stephen V. Scoper, R. Denise Cole, Nancy Crawford, Lisa Franklin, Krista Hamelin, Jen Martin, Rebecca Marx, Gregory Schultz, Joseph Webb, Pamela Yeager, Rosa Y. Kim, Matthew S. Benz, David M. Brown, Eric Chen, Richard H. Fish, Eric Kegley, Laura Shawver, Tien P. Wong, Rebecca De La Garza, Shayla Friday (Hay), P. Kumar Rao, Eve Adcock, Rajendra S. Apte, Amy Baladenski, Rhonda Curtis, Sarah Gould, Amanda Hebden, Jamie Kambarian, Charla Meyer, Sam Pistorius, Melanie Quinn, Greg Rathert, Kevin J. Blinder, Ashley Hartz, Pam Light, Gaurav K. Shah, Russell VanGelder, Michael M. Altaweel, Natalie Kurinij, Diane Brown, Nancy Prusakowski, Larry Hubbard, Janet Wittes, William E. Barlow, Marc Hochberg, Alice T. Lyon, Alan G. Palestine, Lee S. Simon, James T. Rosenbaum, Harmon Smith, Janet Davis, Jennifer Thorne, Nisha R. Acharya, Jeffrey A. Boring, Judith Alexander, Wai Ping Ng, David S. Friedman, Anna Adler, Alyce Burke, Joanne Katz, Susan Reed, Husam Ansari, Nicholas Cohen, Sanjukta Modak, Lea T. Drye, Mark L. Van Natta, Kevin Frick, Thomas A. Louis, David Shade, Karen Pascual, Jill S. Slutsky-Sanon, Colby Glomp, Melissa A. Nieves, Maria Stevens, Amanda Allen, Yasmin Hilal, Francis Abreu, Anne Shanklin Casper, Cathleen Ewing, Adante Hart, Andrea Lears, Shirley Li, Jill Meinert, Vinnette Morrison, Deborah Nowakowski, Girlie Reyes, Dave M. Shade, Jacqueline Smith, Karen Steuernagle, Mark Van Natta, Vidya Venugopal, Tsung Yu, Paul Chen, Karen Collins, John Dodge, Kevin D. Frick, Rosetta Jackson, Christian Jimenez, Ariel Landers, Hope Livingston, Curtis L. Meinert, Sobharani Rayapudi, Weijiang Shen, Charles Shiflett, Rochelle Smith, Ada Tieman, James A. Tonascia, Richard Zheng, James Allan, Wendy K. Benz, Amitha Domalpally, Kristine A. Johnson, Dawn J. Myers, Jeong Won Pak, James L. Reimers, Debra J. Christianson, Geoffrey Chambers, Margaret A. Fleischli, Jacquelyn Freund, Kathleen E. Glander, Anne Goulding, Vonnie Gama, Sapna Gangaputra, Dennis Hafford, Susan E. Harris, Larry D. Hubbard, Jeffrey M. Joyce, Christina N. Kruse, Lauren Nagle, Amy Remm, Gwyn E. Padden-Lechten, Alyson Pohlman, Ruth A. Shaw, Peggy Sivesind, Dennis Thayer, Erika Treichel, Kelly J. Warren, Sheila M. Watson, Mary K. Webster, James K. White, Tara Wilhelmson, and Grace Zhang

Subjects
Adult, Male, Reoperation, medicine.medical_specialty, Time Factors, Dissociation (neuropsychology), Visual acuity, Adolescent, genetic structures, Visual Acuity, Article, law.invention, Uveitis, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Foreign-Body Migration, Randomized controlled trial, Fluocinolone acetonide, Risk Factors, law, medicine, Humans, Glucocorticoids, Aged, Aged, 80 and over, Drug Implants, business.industry, 030503 health policy & services, Middle Aged, medicine.disease, Confidence interval, Surgery, Ophthalmology, Steroid therapy, Fluocinolone Acetonide, Anesthesia, Intravitreal Injections, 030221 ophthalmology & optometry, Equipment Failure, Female, Implant, medicine.symptom, 0305 other medical science, business, Follow-Up Studies, medicine.drug
Abstract

To describe fluocinolone acetonide implant dissociations in the Multicenter Uveitis Steroid Treatment (MUST) Trial.Randomized clinical trial with extended follow-up.Review of data collected on the first implant in the eye(s) of participants. Dissociation was defined as the drug pellet no longer being affixed to the strut and categorized as spontaneous or surgically related.A total of 250 eyes (146 patients) had at least 1 implant placed. Median follow-up time after implant placement was 6 years (range 0.5-9.2 years). Thirty-four dissociations were reported in 30 participants. There were 22 spontaneous events in 22 participants; 6-year cumulative risk of a spontaneous dissociation was 4.8% (95% confidence interval [CI]: 2.4%-9.1%). The earliest event occurred 4.8 years after placement. Nine of 22 eyes with data had a decline in visual acuity ≥5 letters temporally related to the dissociation. Thirty-nine implant removal surgeries were performed, 33 with replacement. Twelve dissociations were noted during implant removal surgeries in 10 participants (26%, 95% CI 15%-48%); 5 of these eyes had a decline in visual acuity ≥5 letters after surgery. The time from implant placement to removal surgery was longer for the surgeries at which dissociated implants were identified than for those without one (5.7 vs 3.7 years, P.001). Overall, visual acuity declined 15 or more letters from pre-implant values in 22% of affected eyes; declines were frequently associated with complications of uveitis or its treatment.There is an increasing risk of dissociation of Retisert implants during follow-up; the risk is greater with removal/exchange surgeries, but the risk of both spontaneous and surgically related events increases with longevity of the implants. In 22% of affected eyes visual acuity declined by 15 letters. In the context of eyes with moderate to severe uveitis for years, this rate is not unexpected.

Published
2016

4. Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis

Author

Andrew D. Dick, James T. Rosenbaum, Hassan A. Al-Dhibi, Rubens Belfort, Antoine P. Brézin, Soon Phaik Chee, Janet L. Davis, Athimalaipet V. Ramanan, Koh-Hei Sonoda, Ester Carreño, Heloisa Nascimento, Sawsen Salah, Sherveen Salek, Jay Siak, Laura Steeples, Massimo Accorinti, Nisha Acharya, Alfredo Adan, Rupesh Agrawal, Nurullah Akkoc, Saed Al Ghamdi, Turki Al Ghamdi, Anood Al Saati, Nasser Alsabaani, Mohamed Al-Shamarani, Artur Bachta, Talin Barisani-Asenbauer, Nicholas Beare, Fernanda Belga Ottoni Porto, Ricardo Blanco, Anita Chan Sook Yee, Vinod Chandran, Christophe Chiquet, Hiok Hee Chng, Andrius Cimbalas, Luca Cimino, Miguel Cordero-Coma, Couto Cristobal, Miguel Cuevas, João Eurico da Fonseca, Joke de Boer, Alejandra de la Torre, Ilse De Schryver, Larissa Derzko-Dzulynsky, David Diaz-Valle, Claudia Eugenia Duran Merino, Andrea Facsko, Luis Figueira, Alejandro Fonollosa, Eric Fortin, Richard Gale, Mauro Galeazzi, Sandra Garcia, Jose Maria Garcia Ruiz de Morales, Nataša Gašperšič, Debra Goldstein, Marta Guedes, Yan Guex-Crosier, Ahmet Gul, Rola Hamam, Muhammad Haroon, Kenichi Hasegawa, Arnd Heiligenhaus, Claire Hooper, Yih-Shiou Hwang, De-Kuang Hwang, Xavier Juanola, Toshikatsu Kaburaki, Sibel Kadayifcilar, John Kempen, Takeshi Kezuka, Amin Kherani, Maarja Kirsimäe, Kaisu Kotaniemi, Aleksandra Kraut, Agnieszka Kubicka-Trząska, Lucia Kuffova, Susan Lightman, Lyndell Lim, Wee Kiak Lim, Peter McCluskey, Mairide McGuire, Pierfrancesco Mirabelli, Elisabetta Miserocchi, Marta Misiuk-Hojło, Cristina Muccioli, Santiago Muñoz, Conor Murphy, Philip I. Murray, Zoltan Nagy, Kenichi Namba, Piergiorgio Neri, Quan Nguyen, Donncha O'Gradaigh, Mohammed Omair, Kati Otsa, Yilmaz Ozyazgan, Franco Pablo, Maria Pia Paroli, Uwe Pleyer, Gyula Poór, Rui Proença, Theodore Rabinovitch, Russell Read, Margarita Rebrov, Claudia Recillas-Gispert, Aniki Rothova, Sergio Schwartzman, Pascal Seve, Srilakshmi Sharma, Joanne Sims, Nicolette Sohár, Eric Suhler, Sándor Szántó, Zsuzsanna Szepessy, Christoph Tappeiner, Jennifer Thorne, Ilknur Tugal Tutkun, Anna Turno-Kręcicka, Joachim Van Calster, Irene van der Horst-Bruinsma, Nataša Vidovič Valentinčič, Albert Vitale, Stephanie Voorduin Ramos, Nenad Vukojevic, Denis Wakefield, François Willermain, Nilufer Yalcindag, Joyce Hisae Yamamoto, Stephen Yeh, Reda Zemaitiene, and Olga Ziouzina

Subjects
030203 arthritis & rheumatology, medicine.medical_specialty, business.industry, MEDLINE, Retrospective cohort study, noninfectious uveitis, noncorticosteroid systemic immunomodulatory agents, Treatment consensus, Evidence-based medicine, CINAHL, Cochrane Library, medicine.disease, law.invention, 03 medical and health sciences, Ophthalmology, 0302 clinical medicine, Systematic review, Randomized controlled trial, law, Family medicine, 030221 ophthalmology & optometry, Medicine, business, Uveitis
Abstract

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016 ; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents ; what data to collect before treatment ; when to modify or withdraw treatment ; how to select agents based on individual efficacy and safety profiles ; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents.

Published
2018

5. Outcome of Treatment of Uveitic Macular Edema

Author

Amani Fawzi, Rahul Khurana, Janet Davis, Lyndell Lim, Oren Tomkins-Netzer, Amitha Domalpally, Kevin Frick, Kanishka Jayasundera, Joanne Katz, Araceli Diaz Perales, Jean-Pierre Hubschman, Shelley Day Ghafoori, and John Kempen

Subjects
medicine.medical_specialty, Visual acuity, genetic structures, medicine.diagnostic_test, business.industry, Fluorescein angiography, medicine.disease, eye diseases, Surgery, Ophthalmology, Fluocinolone acetonide, Edema, medicine, sense organs, Implant, medicine.symptom, business, Prospective cohort study, Macular edema, Uveitis, medicine.drug
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.

Published
2015

6. Intravitreal aflibercept for macular edema secondary to central retinal vein occlusion : 18-month results of the phase 3 GALILEO study

Author

Yuichiro Ogura, Johann Roider, Jean-François Korobelnik, Frank G. Holz, Christian Simader, Ursula Schmidt-Erfurth, Robert Vitti, Alyson J. Berliner, Florian Hiemeyer, Brigitte Stemper, Oliver Zeitz, Rupert Sandbrink, Mark Gillies, Jennifer Arnold, Ian McAllister, Simon Chen, Paul Mitchell, Lyndell Lim, Ulrich Schoenherr, Siegfried Priglinger, François Devin, Michel Paques, Gabriel Quentel, Michel Weber, Catherine Creuzot-Garcher, Frank Holz, Sabine Aisenbrey, Lutz Lothar Hansen, Peter Wiedemann, Chris Patrick Lohmann, Norbert Pfeiffer, Stefan Dithmar, Dirk Sandner, Bernd Kirchhof, Helmut Sachs, Salvatore Grisanti, Nicolas Feltgen, Karl Heinz Emmerich, Lars-Olaf Hattenbach, Peter Walter, Katrin Engelmann, Norbert Bornfeld, Andreea Gamulescu, Gisbert Richard, Berthold Seitz, Stefan Mennel, Daniel Pauleikhoff, Frank Koch, András Papp, József Ferenc Györy, Ágnes Kerényi, András Seres, András Berta, Lajos Szalczer, Francesco Boscia, Alfonso Giovannini, Ugo Menchini, Frederico Ricci, Monica Varanno, Francesco Viola, Rosangela Lattanzio, Alfredo Reibaldi, Frederico Grignolo, Miki Honda, Hiroko Terasaki, Nagahisa Yoshimura, Mitsuko Yuzawa, Motohiro Kamei, Ilze Zarinova, Guna Laganovska, Ranjana Mathur, Caroline Chee, Dong-Heun Nam, Se-Joon Woo, Young-Hee Yoon, Won-Ki Lee, Hyeong-Gon Yu, Hyoung-Jun Koh, and Bornfeld, Norbert (Beitragende*r)

Subjects
medicine.medical_specialty, Visual acuity, business.industry, Medizin, Phases of clinical research, medicine.disease, eye diseases, law.invention, Ophthalmology, Central retinal vein occlusion, Randomized controlled trial, law, medicine, Clinical endpoint, medicine.symptom, Prospective cohort study, business, Macular edema, Aflibercept, medicine.drug
Abstract

Purpose To evaluate intravitreal aflibercept for treatment of macular edema secondary to central retinal vein occlusion (CRVO). Design Randomized, double-masked, phase 3 study. Methods A total of 177 patients with macular edema secondary to CRVO were randomized to receive 2 mg intravitreal aflibercept (n = 106) or sham (n = 71) every 4 weeks for 20 weeks. From weeks 24 to 48, patients were monitored every 4 weeks; the former group received intravitreal aflibercept as needed (PRN), and the sham group received sham. From weeks 52 to 76, patients were monitored every 8 weeks, and both groups received intravitreal aflibercept PRN. The primary endpoint (proportion of patients who gained ≥15 letters) was at week 24. This study reports exploratory outcomes at week 76. Results The proportion of patients who gained ≥15 letters in the intravitreal aflibercept and sham groups was 60.2% vs 22.1% at week 24 (patients discontinued before week 24 were considered nonresponders; P P P .001). Mean μm change from baseline central retinal thickness was −448.6 vs −169.3 at week 24 ( P P P = .1122). Over 76 weeks, the most common ocular serious adverse event in the intravitreal aflibercept group was macular edema (3.8%). Conclusions The visual and anatomic improvements seen after fixed, monthly dosing at week 24 were largely maintained when treatment intervals were extended. Patients with macular edema following CRVO benefited from early treatment with intravitreal aflibercept.

Published
2014

7. Factors Predicting Visual Acuity Outcome in Intermediate, Posterior, and Panuveitis: The Multicenter Uveitis Steroid Treatment (MUST) Trial

Author

John H. Kempen, Mark L. Van Natta, Michael M. Altaweel, James P. Dunn, Douglas A. Jabs, Susan L. Lightman, Jennifer E. Thorne, Janet T. Holbrook, Glenn J. Jaffe, Brenda Branchaud, Paul Hahn, Larry Koreen, Eleonora (Nora) M. Lad, Phoebe Lin, Joseph Nissim Martel, Neha (Shah) Serrano, Cindy Skalak, Lejla Vajzovic, Claxton Baer, Joyce Bryant, Sai Chavala, Michael Cusick, Shelley Day, Pouya Dayani, Justis Ehlers, Muge Kesen, Annie Lee, Alex Melamud, Jawad A. Qureshi, Adrienne Williams Scott, Robert F. See, Robert K. Shuler, Megan Wood, Steven Yeh, Alcides Fernandes, Deborah Gibbs, Donna Leef, Daniel F. Martin, Sunil Srivastava, Hosne Begum, Jeff Boring, Kristen L. Brotherson, Bryn Burkholder, Nicholas J. Butler, Dennis Cain, Mary A. Cook, David Emmert, Janis R. Graul, Mark Herring, Ashley Laing, Theresa G. Leung, Michael C. Mahon, Ahmafreza Moradi, Antonia Nwankwo, Trucian L. Ostheimer, Terry Reed, Ellen Arnold, Patricia M. Barnabie, Marie-Lynn Belair, Stephen G. Bolton, Joseph B. Brodine, Diane M. Brown, Lisa M. Brune, Anat Galor, Theresa Gan, Adam Jacobowitz, Meera Kapoor, Sanjay Kedhar, Stephen Kim, Henry A. Leder, Alison G. Livingston, Yavette Morton, Kisten Nolan, George B. Peters, Priscilla Soto, Ricardo Stevenson, Michelle Tarver-Carr, Yue Wang, C. Stephen Foster, Stephen D. Anesi, Linda Bruner, Olga Ceron, David M. Hinkle, Nancy Persons, Bailey Wentworth, Sarah Acevedo, Fahd Anzaar, Tom Cesca, Angelica Contero, Kayleigh Fitzpatrick, Faith Goronga, Jyothir Johnson, Karina Q. Lebron, Danielle Marvell, Chandra Morgan, Nita Patel, Jennifer Pinto, Sana S. Siddique, Janet Sprague, Taygan Yilmaz, H. Nida Sen, Michael Bono, Denise Cunningham, Darryl Hayes, Dessie Koutsandreas, Robert B. Nussenblatt, Patti R. Sherry, Gregory L. Short, Wendy Smith, Alana Temple, Allison Bamji, Hanna Coleman, Geetaniali Davuluri, Lisa Faia, Chloe Gottlieb, Guy V. Jirawuthiworavong, Julie C. Lew, Richard Mercer, Dominic Obiyor, Cheryl H. Perry, Natalia Potapova, Eric Weichel, Keith J. Wroblewski, Paul A. Latkany, Corinne Coonan, Andrea Honda, Monica Lorenzo-Latkany, Robert Masini, Susan Morell, Angela Nguyen, Jason Badamo, Kenneth M. Boyd, Matthew Enos, Jenny Gallardo, Jacek Jarczynski, Ji Yun Lee, Mirjana McGrosky, Ann Nour, Meredith Sanchez, Kate Steinberg, Richard J. Stawell, Lisa Breayley, Carly D'Sylva, Elizabeth Glatz, Lauren Hodgson, Lyndell Lim, Cecilia Ling, Rachel McIntosh, Julie Morrison (Ewing), Andrew Newton, Sutha Sanmugasundram, Richard Smallwood, Ehud Zamir, Nicola Hunt, Lisa Jones, Ignatios Koukouras, Suzanne Williams, Pauline T. Merrill, Danielle Carns, Len Richine, Denise L. Voskuil-Marre, Kisung Woo, Bruce Gaynes, Christina Giannoulis, Pam Hulvey, Elaine Kernbauer, Heena S. Khan, Sarah J. Levine, Scott Toennessen, Eileen Tonner, Robert C. Wang, Hank Aguado, Sally Arceneaux, Karen Duignan, Gary E. Fish, Nick Hesse, Diana Jaramillo, Michael Mackens, Jean Arnwine, David Callanan, Kimberly Cummings, Keith Gray, Susie Howden, Karin Mutz, Brenda Sanchez, Susan Lightman, Filis Ismetova, Ashley Prytherch, Sophie Seguin-Greenstein, Oren Tomkins, Asat Bar, Kate Edwards, Lavanish Joshi, Jiten Moraji, Ahmed Samy, Timothy Stubbs, Simon Taylor, Hamish Towler, Rebecca Tronnberg, Gary N. Holland, Robert D. Almanzor, Jose Castellanos, Jean Pierre Hubschman, Ann K. Johiro, Alla Kukuyev, Ralph D. Levinson, Colin A. McCannel, Susan S. Ransome, Christine R. Gonzales, Anurag Gupta, Partho S. Kalyani, Michael A. Kapamajian, Peter J. Kappel, Cheryl Arcinue, Janne Chuang, Giulio Barteselli, Glenn Currie, Veronica Mendoza, Debbie Powell, Tom Clark, Denine E. Cochran, William R. Freeman, Joshua Hedaya, Tiara Kemper, Igor Kozak, Jacqueline M. LeMoine, Megan E. Loughran, Luzandra Magana, Francesca Mojana, Victoria Morrison, Vivian Nguyen, Stephen F. Oster, Nisha Acharya, David Clay, Salena Lee, Mary Lew, Todd P. Margolis, Jay Stewart, Ira G. Wong, Debra Brown, Claire M. Khouri, Debra A. Goldstein, Andrea Birnbaum, Andrea Degillio, Gemma De la Rosa, Carmen Ramirez, Evica Simjanowski, Mariner Skelly, Anna L. Castro-Malek, Catherine E. Crooke, Melody Huntley, Katrina Nash, Marcia Niec, Dimitry Pyatetsky, Misel Ramirez, Zuzanna Rozenbajgier, Howard H. Tessler, Janet L. Davis, Thomas A. Albini, Marie Chin, Daniela Castaño, Ariana Elizondo, Macy Ho, Jaclyn L. Kovach, Richard C-S. Lin, Efrem Mandelcorn, Jackie K-D. Nguyen, Aura Pacini, Susan Pineda, David A. Pinto, Jose Rebimbas, Kimberly E. Stepien, Claudia Teran, Susan G. Elner, Hillary Bernard, Linda Fournier, Lindsay Godsey, Linda Goings, Richard Hackel, Moella Hesselgrave, K. Thiran Jayasundera, Robert Prusak, Pamela Titus, Melissa Bergeron, Reneé Blosser, Rebecca Brown, Carrie Chrisman-McClure, Julie R. Gothrup, Stephen J. Saxe, Deanna Sizemore, James Berger, Sheri Drossner, Joan C. DuPont, Albert M. Maguire, Janice Petner, Stephanie Engelhard, Tim Hopkins, Jonathan Lo, Dawn McCall, Monique McRay, Rebecca Salvo, Daniel Will, Wei Xu, Elizabeth Windsor, Laurel Weeney, Peter R. Pavan, Ken Albritton, JoAnn Leto, Brian Madow, Lori Mayor, Scott E. Pautler, Wyatt Saxon, Judy Soto, Burton Goldstein, Amy Klukoff, Lucy Lambright, Kim McDonald, Maria Ortiz, Susan Scymanky, Dee Dee Szalay, Narsing Rao, Tamara Davis, Jackie Douglass, Judith Linton, Margaret Padilla, Sylvia Ramos, Narsing A. Rao, Alexia Aguirre, Lawrence Chong, Lupe Cisneros, Elizabeth Corona, Dean Eliott, Amani Fawzi, Jesse Garcia, Rahul Khurana, Jennifer Lim, Rachel Mead, Julie H. Tsai, Albert Vitale, Paul S. Bernstein, Bonnie Carlstrom, James Gilman, Sandra Hanseen, Paula Morris, Diana Ramirez, Kimberley Wegner, John D. Sheppard, Brianne Anthony, Amber Casper, Lisa Felix-Kent, Jeanette Fernandez, Tari Johnson, Stephen V. Scoper, R. Denise Cole, Nancy Crawford, Lisa Franklin, Krista Hamelin, Jen Martin, Rebecca Marx, Gregory Schultz, Joseph Webb, Pamela Yeager, Rosa Y. Kim, Matthew S. Benz, David M. Brown, Eric Chen, Richard H. Fish, Eric Kegley, Laura Shawver, Tien P. Wong, Rebecca De La Garza, Shayla Friday (Hay), P. Kumar Rao, Eve Adcock, Rajendra S. Apte, Amy Baladenski, Rhonda Curtis, Sarah Gould, Amanda Hebden, Jamie Kambarian, Charla Meyer, Sam Pistorius, Melanie Quinn, Greg Rathert, Kevin J. Blinder, Ashley Hartz, Pam Light, Gaurav K. Shah, Russell VanGelder, Natalie Kurinij, Diane Brown, Nancy Prusakowski, Larry Hubbard, Janet Wittes, William E. Barlow, Marc Hochberg, Alice T. Lyon, Alan G. Palestine, Lee S. Simon, James T. Rosenbaum, Harmon Smith, Janet Davis, Jennifer Thorne, Nisha R. Acharya, Albert T. Vitale, Jeffrey A. Boring, Judith Alexander, Wai Ping Ng, David S. Friedman, Anna Adler, Alyce Burke, Joanne Katz, Susan Reed, Husam Ansari, Nicholas Cohen, Sanjukta Modak, Elizabeth A. Sugar, Alyce E. Burke, Lea T. Drye, Kevin Frick, JoAnn Katz, Thomas A. Louis, David Shade, Karen Pascual, Jill S. Slutsky-Sanon, Amanda Allen, Colby Glomp, Yasmin Hilal, Melissa A. Nieves, Maria Stevens, Francis Abreu, Anne Shanklin Casper, Cathleen Ewing, Adante Hart, Andrea Lears, Shirley Li, Jill Meinert, Vinnette Morrison, Deborah Nowakowski, Girlie Reyes, Dave M. Shade, Jacqueline Smith, Karen Steuernagle, Mark Van Natta, Vidya Venugopal, Tsung Yu, Paul Chen, Karen Collins, John Dodge, Kevin D. Frick, Rosetta Jackson, Christian Jimenez, Ariel Landers, Hope Livingston, Curtis L. Meinert, Sobharani Rayapudi, Weijiang Shen, Charles Shiflett, Rochelle Smith, Ada Tieman, James A. Tonascia, Richard Zheng, James Allan, Wendy K. Benz, Amitha Domalpally, Kristine A. Johnson, Dawn J. Myers, Jeong Won Pak, James L. Reimers, Geoffrey Chambers, Debra J. Christianson, Margaret A. Fleischli, Jacquelyn Freund, Vonnie Gama, Sapna Gangaputra, Kathleen E. Glander, Anne Goulding, Dennis Hafford, Susan E. Harris, Larry D. Hubbard, Jeffrey M. Joyce, Christina N. Kruse, Lauren Nagle, Gwyn E. Padden-Lechten, Alyson Pohlman, Amy Remm, Ruth A. Shaw, Peggy Sivesind, Dennis Thayer, Erika Treichel, Kelly J. Warren, Sheila M. Watson, Mary K. Webster, James K. White, Tara Wilhelmson, and Grace Zhang

Subjects
Male, medicine.medical_specialty, Time Factors, Triamcinolone acetonide, Visual acuity, genetic structures, Visual Acuity, Article, law.invention, Fluocinolone acetonide, Randomized controlled trial, law, Ophthalmology, Panuveitis, medicine, Humans, Glucocorticoids, Macular edema, Aged, Drug Implants, business.industry, Middle Aged, medicine.disease, eye diseases, Treatment Outcome, Female, sense organs, medicine.symptom, business, Tomography, Optical Coherence, Uveitis, Follow-Up Studies, medicine.drug, Cohort study
Abstract

To identify factors associated with best-corrected visual acuity (BCVA) presentation and 2-year outcome in 479 intermediate, posterior, and panuveitic eyes.Cohort study using randomized controlled trial data.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.Baseline factors significantly associated with reduced BCVA included age ≥50 vs50 years; posterior vs intermediate uveitis; uveitis duration10 vs6 years; anterior chamber (AC) flaregrade 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 or10 vs6 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.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.

Published
2015

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