Uveitic Edema Often Relapses After Steroid Treatment
Ophthalmology, May 2021
Tomkins-Netzer et al. conducted longitudinal follow-up of patients with uveitic macular edema enrolled in the Multicenter Uveitis Steroid Treatment (MUST) trial. They found that seven years after treatment, 43% of patients experienced at least one episode of relapse, suggesting the need for ongoing monitoring with OCT.
The MUST study included 177 patients (248 eyes) with a mean age of 52 years. OCT measurements were obtained at baseline and annually thereafter, and visual acuity (VA) was measured at each visit. Macular edema was defined as a center macular thickness (CMT) of ≥240 μm on time-domain OCT or equivalent. Resolution of edema was defined as normalization of CMT on OCT. Relapse denoted an increase in CMT to ≥240 μm detected in an eye with previous resolution. Main outcome measures were VA and resolution of macular edema or relapse.
Information on short-acting regional corticosteroid treatment was available for 227 eyes. Of these, 40% received at least one corticosteroid injection. The overall injection rate was 0.53 per eye year. The cumulative percentage of macular edema resolution at any point during the seven years of follow-up was 94%. Presence of epiretinal membrane on OCT was linked to lower likelihood of edema resolution (hazard ratio [HR], 0.74; p = .05).
Among 177 eyes with resolution of edema, the cumulative percentage of relapse within seven years was 43%. Eyes with resolved edema gained a mean of 6.24 letters (p < .001). Eyes without resolution of edema had no gain in vision (mean change, –1.30 letters; p = .065). Eyes that developed macular edema during the year (incident or relapsed) lost a mean of 8.65 letters (p < .001).
When given sufficient time and treatment, nearly all uveitic macular edema resolves, even though episodes of relapse are common, the authors said. Because VA was superior for eyes with resolved edema, they suggest that inflammation control and edema resolution may be visually relevant treatment goals.
The original article can be found here.