Risk factors for reduced visual acuity in non-infectious intermediate, posterior, and panuveitis

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