By Khalid F. Tabbara, MD
This large retrospective study found that long-term functional outcomes were good in uveitis patients, with visual acuity remaining stable in 80% of patients.
The authors evaluated the long-term functional outcomes and causes of visual loss in 1,076 patients with anterior, intermediate or posterior uveitis or panuveitis seen from 2011 to 2013 at Moorfields Eye Hospital in London.
At 10 years’ follow-up, the average BCVA remained stable for all patients. Visual loss occurred in 19% of eyes, with an incidence of 0.01 per eye-year or 0.02 per patient-year both for moderate visual loss and for severe visual loss. Patients with posterior, intermediate or panuveitis had a higher risk of visual loss.
Causes of visual loss included retinal detachment, cystoid macular edema (CME), macular scarring, macular hole, optic neuropathy, macular ischemia and vitreous opacities. The most common causes of visual loss were chronic CME and macular scarring, occurring in 3.55% and 4% of patients, respectively. The average number of follow-up examinations was 5.9 per year.
Among 525 patients (48.7%) who received oral prednisolone, 320 required a dose of more than 40 mg/day and 130 also required one or more second-line agents. Patients were seen on average 33.7 times total, or 5.9 times/year.
The authors conclude that although medical therapy may preserve vision, the burden of disease in the form of frequent clinical visits and use of systemic and local immunosupression and immunomodulation, as well as treatment of related side-effects, is a significant concern among these patients. Early diagnosis and more aggressive therapy focusing on macular pathology can reduce the degree of visual loss in the future.