Using data from the multicenter uveitis steroid treatment (MUST) trial, investigators aimed to identify factors associated with reduced visual acuity at baseline and the end of the 2-year follow-up.
Study design
The MUST trial randomized 479 uveitic eyes from 255 patients to receive either systemic corticosteroid therapy supplemented by systemic immunosuppressive therapy when necessary, or a fluocinolone acetonide implant after initial quieting of the anterior chamber (AC) using topical, injected, and/or oral corticosteroid therapy. All patients were permitted use of topical corticosteroids as needed without restriction.
For this analysis, investigators included only eyes that had complete visual acuity information at baseline and attended all follow-up visits.
Outcomes
Decreased vision at the time of enrollment was significantly associated with age greater or equal to 50 years, posterior uveitis (vs. intermediate), duration of disease (>10 years vs. <6 years), AC flare above grade 0, cataract, macular thickening on OCT, and exudative retinal detachment.
Loss of vision during follow-up, defined as a decrease of 3 or more lines, was significantly associated with pseudophakia at baseline, cataract at baseline and through follow-up, AC flare during follow-up, incidence of vitreous haze or persistence of haze from baseline to 2 years, and macular thickening. The authors also found duration of disease had a dose-response relationship on VA decrease during follow-up.Treatment assignment, age, sex, smoking status,
Treatment assignment, age, sex, smoking status, presence of diabetes and laterality of disease were not found to be associated with 2-year changes in BCVA. Despite differences in mean baseline vision, the average magnitude of visual improvement was similar across all types of uveitis.
Overall, prognosis was good for both the fluocinolone implant and systemic treatment groups. Eyes with worse baseline vision showed the greatest improvements during follow-up, and eyes with presenting VA of >20/50 showed little change, perhaps representing a “ceiling effect” for such treatment.
Limitations
There were no problems with the design, though follow-up time is quite brief. Some complications of the steroid implant, such as a spontaneous break at the strut, rarely if ever occur before 5 years, and would therefore not be captured in the results. However, subsequent reports have been published that cover longer time periods.