April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Risk factors for reduced visual acuity in non-infectious intermediate, posterior, and panuveitis
Author Affiliations & Notes
  • Douglas A Jabs
    Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY
  • Mark L Van Natta
    Biostatistics & Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
  • Michael M Altaweel
    Ophthalmology & Visual Science, University of Wisconsin-Madison, Madison, WI
  • James P Dunn
    Biostatistics & Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
  • Susan Lightman
    Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
  • Jennifer E Thorne
    Biostatistics & Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
  • Janet T Holbrook
    Biostatistics & Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
  • John H Kempen
    Ophthalmology, Biostatistics, & Epidemiology, Scheie Eye Institute, University of Penn, Philadelphia, PA
  • Footnotes
    Commercial Relationships Douglas Jabs, None; Mark Van Natta, None; Michael Altaweel, None; James Dunn, None; Susan Lightman, None; Jennifer Thorne, None; Janet Holbrook, None; John Kempen, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 6033. doi:
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      Douglas A Jabs, Mark L Van Natta, Michael M Altaweel, James P Dunn, Susan Lightman, Jennifer E Thorne, Janet T Holbrook, John H Kempen, ; Risk factors for reduced visual acuity in non-infectious intermediate, posterior, and panuveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6033.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To identify risk factors for reduced visual acuity in cases of non-infectious intermediate, posterior, and panuveitis.

 
Methods
 

Baseline data from the Multicenter Uveitis Steroid Treatment (MUST) Trial were analyzed. Patients were enrolled with active or recently active intermediate (+/- anterior), posterior or panuveitis for which systemic corticosteroid therapy was indicated and were randomized to treatment with standardized systemic therapy or fluocinolone acetonide implant therapy. Best-corrected visual acuity (BCVA) was measured on logarithmic visual acuity charts, and data regarding demographic and clinical characteristics were derived via the study protocol administered across the 23 clinical centers and Reading Center.

 
Results
 

Among 479 uveitic eyes (of 255 patients) enrolled, 475 had baseline BCVA data, among which 199 (42%, 95% confidence interval, 37-47%) presented with BCVA 20/50 or worse. At baseline, risk factors associated with reduced BCVA included: age≥50 vs. <50 years (-0.8 BCVA lines; p=0.05); posterior or panuveitis vs. intermediate uveitis (-1.4 BCVA lines; p<0.001); duration of uveitis >10 vs. <6 years (-2.0 BCVA lines; p<0.001); hypotony (-1.6 BCVA lines; p=0.05); anterior chamber (AC) flare (-1.4 BCVA lines; P=0.004); cataract (-2.1 BCVA lines; p<0.001) or prior cataract surgery (-2.0 BCVA lines; p<0.001); macular edema on OCT with thickness of > 340 μm vs. <240 (-3.0 BCVA lines; p<0.001) ; and exudative retinal detachment (-2.4 BCVA lines; p=0.001). Higher levels of current AC cells and vitreous haze were associated with reduced visual acuity in the crude but not adjusted analyses.

 
Conclusions
 

Risk factors for reduced visual acuity included increased age, posterior or panuveitis vs. intermediate uveitis, longer duration of uveitis, and the presence of multiple complications of inflammation. Current activity of inflammation (AC cells and vitreous haze) was strongly associated with increased risk in the crude analysis, but not after adjusting for complications of inflammation and other factors. These results suggest that steady control of inflammation that prevents the occurrence of ocular complications thereof would be expected to improve visual acuity outcome.

 
Keywords: 746 uveitis-clinical/animal model • 754 visual acuity • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials  
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