Factors Predicting Visual Acuity Outcome in Intermediate, Posterior, and Panuveitis: The Multicenter Uveitis Steroid Treatment (MUST) Trial - 14/11/15
Doi : 10.1016/j.ajo.2015.09.017
John H. Kempen a, b, c, ⁎ 
, Mark L. Van Natta d, e, Michael M. Altaweel f, James P. Dunn g, h, Douglas A. Jabs d, e, i, j, Susan L. Lightman k, l, Jennifer E. Thorne d, e, m, Janet T. Holbrook d, e
for
, Mark L. Van Natta d, e, Michael M. Altaweel f, James P. Dunn g, h, Douglas A. Jabs d, e, i, j, Susan L. Lightman k, l, Jennifer E. Thorne d, e, m, Janet T. Holbrook d, efor
The Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group
Glenn J. Jaffe, MD : Director, Brenda Branchaud, COT, Paul Hahn, MD, PhD, Larry Koreen, MD, PhD, MPH, Eleonora (Nora) M. Lad, Phoebe Lin, Joseph Nissim Martel, Neha (Shah) Serrano, MD, Cindy Skalak, RN, COT, Lejla Vajzovic, MD, Claxton Baer, MD : Former Member, Joyce Bryant, COT : Former Member, Sai Chavala, MD : Former Member, Michael Cusick, MD : Former Member, Shelley Day, MD : Former Member, Pouya Dayani, MD : Former Member, Justis Ehlers, MD : Former Member, Muge Kesen, MD : Former Member, Annie Lee, MD : Former Member, Alex Melamud, MD : Former Member, Jawad A. Qureshi, MD : Former Member, Adrienne Williams Scott : Former Member, Robert F. See, MD : Former Member, Robert K. Shuler, MD : Former Member, Megan Wood, MS, COA : Former Member, Steven Yeh, MD : Director, Alcides Fernandes, MD, Deborah Gibbs, COMT, CCRC, Donna Leef, COMT, Daniel F. Martin, MD : Former Member, Sunil Srivastava, MD : Former Member, James P. Dunn, MD : Director, Hosne Begum, MBBS, MPH, Jeff Boring, COA, Kristen L. Brotherson, BS, Bryn Burkholder, MD, Nicholas J. Butler, MD, Dennis Cain, Mary A. Cook, BA, MS, David Emmert, Janis R. Graul, Mark Herring, Ashley Laing, MD, Theresa G. Leung, MD, Michael C. Mahon, BS, Ahmafreza Moradi, MD, Antonia Nwankwo, BS, Trucian L. Ostheimer, MD, Terry Reed, COA, Ellen Arnold, BS : Former Member, Patricia M. Barnabie, BS : Former Member, Marie-Lynn Belair, MD : Former Member, Stephen G. Bolton, CRNP : Former Member, Joseph B. Brodine : Former Member, Diane M. Brown, MSN, RN : Former Member, Lisa M. Brune, BSN, RN : Former Member, Anat Galor, MD : Former Member, Theresa Gan, MD : Former Member, Adam Jacobowitz, MD : Former Member, Meera Kapoor : Former Member, Sanjay Kedhar, MD : Former Member, Stephen Kim, MD : Former Member, Henry A. Leder, MD : Former Member, Alison G. Livingston, BSN, RN : Former Member, Yavette Morton : Former Member, Kisten Nolan, BSN, MPH, RN : Former Member, George B. Peters, MD, MBA : Former Member, Priscilla Soto : Former Member, Ricardo Stevenson, MD : Former Member, Michelle Tarver-Carr, MD, PhD : Former Member, Yue Wang, MD, PhD : Former Member, C. Stephen Foster, MD : Director, Stephen D. Anesi, MD, Linda Bruner, Olga Ceron, MD, David M. Hinkle, MD, Nancy Persons, Bailey Wentworth, Sarah Acevedo, MD : Former Member, Fahd Anzaar, MD : Former Member, Tom Cesca : Former Member, Angelica Contero : Former Member, Kayleigh Fitzpatrick : Former Member, Faith Goronga : Former Member, Jyothir Johnson : Former Member, Karina Q. Lebron, MD : Former Member, Danielle Marvell : Former Member, Chandra Morgan : Former Member, Nita Patel, MSW : Former Member, Jennifer Pinto : Former Member, Sana S. Siddique : Former Member, Janet Sprague : Former Member, Taygan Yilmaz : Former Member, H. Nida Sen, MD, MHSc : Director, Michael Bono, Denise Cunningham, CRA, Darryl Hayes, COA, Dessie Koutsandreas, BS, COA, Robert B. Nussenblatt, MD, Patti R. Sherry, BSN, Gregory L. Short, COMT, Wendy Smith, MD, Alana Temple, BSN, Allison Bamji, RN : Former Member, Hanna Coleman, MD : Former Member, Geetaniali Davuluri, MD : Former Member, Lisa Faia, MD : Former Member, Chloe Gottlieb, MD : Former Member, Guy V. Jirawuthiworavong, MD : Former Member, Julie C. Lew, MD : Former Member, Richard Mercer, COT : Former Member, Dominic Obiyor, BSN : Former Member, Cheryl H. Perry, BSN : Former Member, Natalia Potapova, MD : Former Member, Eric Weichel, MD : Former Member, Keith J. Wroblewski, MD : Former Member, Steven Yeh, MD : Former Member, Paul A. Latkany, MD : Director, Corinne Coonan, Andrea Honda, MD, Monica Lorenzo-Latkany, MD, Robert Masini, MD, Susan Morell, Angela Nguyen, Jason Badamo : Former Member, Kenneth M. Boyd : Former Member, Matthew Enos : Former Member, Jenny Gallardo : Former Member, Jacek Jarczynski : Former Member, Ji Yun Lee : Former Member, Mirjana McGrosky : Former Member, Ann Nour : Former Member, Meredith Sanchez : Former Member, Kate Steinberg : Former Member, Richard J. Stawell, MD : Director, Lisa Breayley, Carly D'Sylva, Elizabeth Glatz, Lauren Hodgson, Lyndell Lim, MD, Cecilia Ling, MD, Rachel McIntosh, Julie Morrison (Ewing), Andrew Newton, Sutha Sanmugasundram, Richard Smallwood, Ehud Zamir, MD, Nicola Hunt : Former Member, Lisa Jones : Former Member, Ignatios Koukouras : Former Member, Suzanne Williams : Former Member, Pauline T. Merrill, MD : Director, Danielle Carns, Len Richine, Denise L. Voskuil-Marre, BS, Kisung Woo, Bruce Gaynes : Former Member, Christina Giannoulis : Former Member, Pam Hulvey : Former Member, Elaine Kernbauer : Former Member, Heena S. Khan, BA : Former Member, Sarah J. Levine : Former Member, Scott Toennessen : Former Member, Eileen Tonner, CC, VA, DS : Former Member, Robert C. Wang, MD : Director, Hank Aguado, Sally Arceneaux, Karen Duignan, Gary E. Fish, MD, Nick Hesse, Diana Jaramillo, Michael Mackens, Jean Arnwine : Former Member, David Callanan, MD : Former Member, Kimberly Cummings : Former Member, Keith Gray : Former Member, Susie Howden : Former Member, Karin Mutz : Former Member, Brenda Sanchez : Former Member, Susan Lightman, MD, PhD : Director, Filis Ismetova, MD, Ashley Prytherch, Sophie Seguin-Greenstein, Oren Tomkins, Asat Bar : Former Member, Kate Edwards : Former Member, Lavanish Joshi : Former Member, Jiten Moraji : Former Member, Ahmed Samy, MD : Former Member, Timothy Stubbs : Former Member, Simon Taylor, MD : Former Member, Hamish Towler : Former Member, Rebecca Tronnberg : Former Member, Gary N. Holland, MD : Director, Robert D. Almanzor, COA, Jose Castellanos, COT, Jean Pierre Hubschman, MD, Ann K. Johiro, NP, Alla Kukuyev, MD, Ralph D. Levinson, MD, Colin A. McCannel, MD, Susan S. Ransome, MD, Christine R. Gonzales, MD : Former Member, Anurag Gupta, MD : Former Member, Partho S. Kalyani, MD : Former Member, Michael A. Kapamajian, MD : Former Member, Peter J. Kappel, MD : Former Member, Cheryl Arcinue, MD : Director, Janne Chuang, Giulio Barteselli, MD, Glenn Currie, Veronica Mendoza, Debbie Powell, BBA, Tom Clark, BSc, CRA : Former Member, Denine E. Cochran, COT, CCRC : Former Member, William R. Freeman, MD : Former Member, Joshua Hedaya, MD : Former Member, Tiara Kemper : Former Member, Igor Kozak, MD : Former Member, Jacqueline M. LeMoine : Former Member, Megan E. Loughran, BA : Former Member, Luzandra Magana : Former Member, Francesca Mojana, MD : Former Member, Victoria Morrison, MD : Former Member, Vivian Nguyen : Former Member, Stephen F. Oster, MD : Former Member, Nisha Acharya, MD : Director, David Clay, Salena Lee, OD, Mary Lew, BA, Todd P. Margolis, MD, Jay Stewart, MD, Ira G. Wong, MD, Debra Brown : Former Member, Claire M. Khouri, BA : Former Member, Debra A. Goldstein, MD : Director, Andrea Birnbaum, MD, PhD, Andrea Degillio, CRA, Gemma De la Rosa, COT, Carmen Ramirez, Evica Simjanowski, CRA, Mariner Skelly, CRA, Anna L. Castro-Malek, BA, CCRC : Former Member, Catherine E. Crooke : Former Member, Melody Huntley : Former Member, Katrina Nash : Former Member, Marcia Niec : Former Member, Dimitry Pyatetsky, MD : Former Member, Misel Ramirez : Former Member, Zuzanna Rozenbajgier, MS : Former Member, Howard H. Tessler, MD : Former Member, Janet L. Davis, MD : Director, Thomas A. Albini, MD, Marie Chin, Daniela Castaño : Former Member, Ariana Elizondo, BS, CCRP : Former Member, Macy Ho : Former Member, Jaclyn L. Kovach, MD : Former Member, Richard C-S. Lin, MD : Former Member, Efrem Mandelcorn : Former Member, Jackie K-D. Nguyen, MD : Former Member, Aura Pacini : Former Member, Susan Pineda : Former Member, David A. Pinto : Former Member, Jose Rebimbas : Former Member, Kimberly E. Stepien, MD : Former Member, Claudia Teran : Former Member, Susan G. Elner, MD : Director, Hillary Bernard, Linda Fournier, COT, Lindsay Godsey, Linda Goings, Richard Hackel, Moella Hesselgrave, COA, K. Thiran Jayasundera, MD, Robert Prusak, Pamela Titus, COT, Melissa Bergeron, COA : Former Member, Reneé Blosser, COMT : Former Member, Rebecca Brown, COA : Former Member, Carrie Chrisman-McClure : Former Member, Julie R. Gothrup, COA : Former Member, Stephen J. Saxe, MD : Former Member, Deanna Sizemore, COA : Former Member, John H. Kempen, MD, PhD : Director, James Berger, Sheri Drossner, Joan C. DuPont, Albert M. Maguire, MD, Janice Petner, Stephanie Engelhard, Tim Hopkins, MD : Former Member, Jonathan Lo : Former Member, Dawn McCall : Former Member, Monique McRay : Former Member, Rebecca Salvo : Former Member, Daniel Will, MD : Former Member, Wei Xu : Former Member, Elizabeth Windsor : Former Member, Laurel Weeney : Former Member, Peter R. Pavan, MD : Director, Ken Albritton, JoAnn Leto, Brian Madow, MD, Lori Mayor, Scott E. Pautler, MD, Wyatt Saxon, Judy Soto, Burton Goldstein, MD : Former Member, Amy Klukoff : Former Member, Lucy Lambright : Former Member, Kim McDonald : Former Member, Maria Ortiz : Former Member, Susan Scymanky : Former Member, Dee Dee Szalay : Former Member, Narsing Rao, MD : Director, Tamara Davis, Jackie Douglass, Judith Linton, Margaret Padilla, CCRP, Sylvia Ramos, Narsing A. Rao, MD, Alexia Aguirre : Former Member, Lawrence Chong, MD : Former Member, Lupe Cisneros, COA : Former Member, Elizabeth Corona : Former Member, Dean Eliott, MD : Former Member, Amani Fawzi, MD : Former Member, Jesse Garcia : Former Member, Rahul Khurana, MD : Former Member, Jennifer Lim, MD : Former Member, Rachel Mead : Former Member, Julie H. Tsai, MD : Former Member, Albert Vitale, MD : Director, Paul S. Bernstein, MD, PhD, Bonnie Carlstrom, COA, James Gilman, CRA, Sandra Hanseen, COA, Paula Morris, CRA, Diana Ramirez, Kimberley Wegner, BS, CRC, John D. Sheppard, MD, MMSc : Director, Brianne Anthony, Amber Casper, Lisa Felix-Kent, COA, Jeanette Fernandez, COMT, Tari Johnson, BS, Stephen V. Scoper, MD, R. Denise Cole : Former Member, Nancy Crawford : Former Member, Lisa Franklin : Former Member, Krista Hamelin : Former Member, Jen Martin : Former Member, Rebecca Marx : Former Member, Gregory Schultz, DD : Former Member, Joseph Webb, BS : Former Member, Pamela Yeager : Former Member, Rosa Y. Kim, MD : Director, Matthew S. Benz, MD, David M. Brown, MD, Eric Chen, MD, Richard H. Fish, MD, Eric Kegley, BA, CRA, COA, Laura Shawver, CCRP, COT, Tien P. Wong, MD, Rebecca De La Garza : Former Member, Shayla Friday (Hay) : Former Member, Karin Mutz : Former Member, P. Kumar Rao, MD : Director, Eve Adcock, Rajendra S. Apte, MD, PhD, Amy Baladenski, Rhonda Curtis, Sarah Gould, Amanda Hebden, Jamie Kambarian, Charla Meyer, Sam Pistorius, Melanie Quinn, Greg Rathert, Kevin J. Blinder, MD : Former Member, Ashley Hartz : Former Member, Pam Light : Former Member, Gaurav K. Shah, MD : Former Member, Russell VanGelder, MD, PhD : Former Member, Douglas A. Jabs, MD, MBA : Chair, Michael M. Altaweel, MD, Janet T. Holbrook, PhD, MPH, John H. Kempen, MD, PhD, Natalie Kurinij, PhD, Douglas A. Jabs, MD, MBA : Chair, Robert D. Almanzor, COA, Michael M. Altaweel, Diane Brown, James P. Dunn, MD, Janet T. Holbrook, PhD, MPH, Gary N. Holland, MD, John H. Kempen, MD, PhD, Rosa Y. Kim, MD, Natalie Kurinij, PhD, Nancy Prusakowski, MS, Jennifer E. Thorne, MD, PhD, Stephen G. Bolton, RN, BSN : Former Member, Lisa M. Brune, RN, BSN : Former Member, Tom Clark, CRA : Former Member, James Gilman : Former Member, Larry Hubbard, MAT : Former Member, Daniel F. Martin, MD : Former Member, Robert B. Nussenblatt, MD : Former Member, Janet Wittes, PhD : Chair, William E. Barlow, PhD, Marc Hochberg, MD, Alice T. Lyon, MD, Alan G. Palestine, MD, Lee S. Simon, MD, Michael M. Altaweel, MD : Nonvoting Member, Janet T. Holbrook, PhD, MPH : Nonvoting Member, Douglas A. Jabs, MD, MBA : Nonvoting Member, Natalie Kurinij, PhD : Nonvoting Member, James T. Rosenbaum, MD : Former Member, Harmon Smith, PhD : Former Member, John H. Kempen, MD, PhD : Chair, Glenn J. Jaffe, MD, Janet Davis, MD : Former Member, James P. Dunn, MD : Former Member, Daniel F. Martin, MD : Former Member, Jennifer Thorne, MD : Former Member, Albert Vitale, MD : Former Member, Jennifer E. Thorne, MD, PhD : Chair, Nisha R. Acharya, MD, MS, Douglas A. Jabs, MD, MBA, John H. Kempen, MD, PhD, Paul A. Latkany, MD, Albert T. Vitale, MD, Robert B. Nussenblatt, MD, MPH : Former Member, Russell VanGelder, MD, PhD : Former Member, Robert D. Almanzor, COA : Chair, Jeffrey A. Boring, COA, Deborah Gibbs, COMT, CCRC, Salena Lee, OD, FAAO, Nancy Prusakowski, Jennifer E. Thorne, MD, PhD : Advisor, Judith Alexander, BA, CCRP : Former Member, Wai Ping Ng, BS : Former Member, David S. Friedman, MD : Chair, Anna Adler, MS, Judith Alexander, BA, CCRP, Alyce Burke, MPH, Janet T. Holbrook, PhD, MPH, Joanne Katz, ScD, John H. Kempen, MD, PhD, Nancy Prusakowski, MS, Susan Reed, BS, Jennifer E. Thorne, MD, PhD, Husam Ansari, MD, PhD : consultant, Nicholas Cohen, MS : Former Member, Sanjukta Modak, MS : Former Member, Wai Ping Ng, BS : Former Member, Elizabeth A. Sugar, PhD : Chair, Alyce E. Burke, MPH, Lea T. Drye, PhD, Janet T. Holbrook, PhD, MPH, Mark L. Van Natta, MHS, Kevin Frick, PhD : Former Member, JoAnn Katz, ScD : Former Member, Thomas A. Louis, PhD : Former Member, Sanjukta Modak, MS : Former Member, David Shade, JD : Former Member, Douglas A. Jabs, MD, MBA : Study Chairman, Karen Pascual, MBA, Jill S. Slutsky-Sanon, MPA, Amanda Allen : Former Member, Colby Glomp : Former Member, Yasmin Hilal, MHS : Former Member, Melissa A. Nieves, BA : Former Member, Maria Stevens, CM : Former Member, Janet T. Holbrook, PhD, MPH : Director, Francis Abreu, ScM, Alyce Burke, MPH, Anne Shanklin Casper, MA, Lea T. Drye, PhD, Cathleen Ewing, David S. Friedman, MD, PhD, Adante Hart, BS, Andrea Lears, BS, Shirley Li, Jill Meinert, Vinnette Morrison, BS, Deborah Nowakowski, Nancy Prusakowski, MS, Girlie Reyes, BS, Dave M. Shade, JD, Jacqueline Smith, AA, Karen Steuernagle, Elizabeth A. Sugar, PhD, Jennifer E. Thorne, MD, PhD, Mark Van Natta, MHS, Vidya Venugopal, MS, Tsung Yu, ScM, Anna Adler, MS : Former Member, Judith Alexander, BA : Former Member, Jeff Boring, COA : Former Member, Paul Chen : Former Member, Nicholas Cohen, MS : Former Member, Karen Collins : Former Member, John Dodge : Former Member, Kevin D. Frick, PhD : Former Member, Rosetta Jackson : Former Member, Christian Jimenez : Former Member, Joanne Katz, ScD : Former Member, Ariel Landers : Former Member, Hope Livingston : Former Member, Thomas A. Louis, PhD : Former Member, Curtis L. Meinert, PhD : Former Member, Sanjukta Modak, MS : Former Member, Wai Ping Ng, BS : Former Member, Sobharani Rayapudi, MD, ScM : Former Member, Weijiang Shen, MS : Former Member, Charles Shiflett, BS : Former Member, Rochelle Smith, BS : Former Member, Ada Tieman, MBA : Former Member, James A. Tonascia, PhD : Former Member, Richard Zheng, MS : Former Member, Michael M. Altaweel, MD : Director, James Allan, BSc, Wendy K. Benz, PhD, Amitha Domalpally, MD, Kristine A. Johnson, Dawn J. Myers, BS, Jeong Won Pak, PhD, Susan Reed, BS, James L. Reimers, BA, Geoffrey Chambers, MS : Former Member, Debra J. Christianson, BS : Former Member, Margaret A. Fleischli, AB, DVM : Former Member, Jacquelyn Freund, MS : Former Member, Vonnie Gama : Former Member, Sapna Gangaputra, MD, MPH : Former Member, Kathleen E. Glander, BBA : Former Member, Anne Goulding, BA : Former Member, Dennis Hafford : Former Member, Susan E. Harris, MS : Former Member, Larry D. Hubbard, MAT : Former Member, Jeffrey M. Joyce, MS : Former Member, Christina N. Kruse, BA : Former Member, Lauren Nagle : Former Member, Gwyn E. Padden-Lechten, BS : Former Member, Alyson Pohlman, BA : Former Member, Amy Remm, BS : Former Member, Ruth A. Shaw, BS : Former Member, Peggy Sivesind : Former Member, Dennis Thayer : Former Member, Erika Treichel, DVM : Former Member, Kelly J. Warren, RN, BS, MSES : Former Member, Sheila M. Watson, BS, DVM : Former Member, Mary K. Webster, BS : Former Member, James K. White, BME : Former Member, Tara Wilhelmson, BS : Former Member, Grace Zhang, BA : Former Member
a Ocular Inflammation Service, Department of Ophthalmology/Scheie Eye Institute, The University of Pennsylvania, Philadelphia, Pennsylvania
b Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology/Scheie Eye Institute, The University of Pennsylvania, Philadelphia, Pennsylvania
c Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, The University of Pennsylvania, Philadelphia, Pennsylvania
d Center for Clinical Trials, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
e Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
f Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin
g Mid-Atlantic Retina, Philadelphia, Pennsylvania
h Wills Eye Hospital, Philadelphia, Pennsylvania
i Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York
j Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
k University College London Institute of Ophthalmology, London, United Kingdom
l Moorfields Eye Hospital, London, United Kingdom
m Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
∗Inquiries to John H. Kempen, Departments of Ophthalmology and Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, 3535 Market St, Suite 700, Philadelphia, PA 19104
Abstract |
Purpose |
To identify factors associated with best-corrected visual acuity (BCVA) presentation and 2-year outcome in 479 intermediate, posterior, and panuveitic eyes.
Design |
Cohort study using randomized controlled trial data.
Methods |
Multicenter Uveitis Steroid Treatment (MUST) Trial masked BCVA measurements at baseline and at 2 years follow-up used gold-standard methods. Twenty-three clinical centers documented characteristics per protocol, which were evaluated as potential predictive factors for baseline BCVA and 2-year change in BCVA.
Results |
Baseline factors significantly associated with reduced BCVA included age ≥50 vs <50 years; posterior vs intermediate uveitis; uveitis duration >10 vs <6 years; anterior chamber (AC) flare >grade 0; cataract; macular thickening; and exudative retinal detachment. Over 2 years, eyes better than 20/50 and 20/50 or worse at baseline improved, on average, by 1 letter (P = .52) and 10 letters (P < .001), respectively. Both treatment groups and all sites of uveitis improved similarly. Factors associated with improved BCVA included resolution of active AC cells, resolution of macular thickening, and cataract surgery in an initially cataractous eye. Factors associated with worsening BCVA included longer duration of uveitis (6–10 or >10 vs <6 years), incident AC flare, cataract at both baseline and follow-up, pseudophakia at baseline, persistence or incidence of vitreous haze, and incidence of macular thickening.
Conclusions |
Intermediate, posterior, and panuveitis have a similarly favorable prognosis with both systemic and fluocinolone acetonide implant treatment. Eyes with more prolonged/severe inflammatory damage and/or inflammatory findings initially or during follow-up have a worse visual acuity prognosis. The results indicate the value of implementing best practices in managing inflammation.
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Vol 160 - N° 6
P. 1133 - décembre 2015 Retour au numéro
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