TY - JOUR
T1 - Cataract Surgery Outcomes in Uveitis
T2 - The Multicenter Uveitis Steroid Treatment Trial
AU - Sen, H. Nida
AU - Abreu, Francis M.
AU - Louis, Thomas A.
AU - Sugar, Elizabeth A.
AU - Altaweel, Michael M.
AU - Elner, Susan G.
AU - Holbrook, Janet T.
AU - Jabs, Douglas A.
AU - Kim, Rosa Y.
AU - Kempen, John H.
N1 - Funding Information:
Supported by the National Eye Institute, National Institutes of Health, Bethesda, Maryland (Collaborative Agreement nos.: U10EY014655 [D.A.J.], U10EY014660 [J.T.H.], and U10EY014656 [M.M.A.]); and the National Eye Institute Intramural Research Program (H.N.S.) (Bethesda, MD). Bausch & Lomb (Rochester, NY) provided support to the study in the form of donation of fluocinolone implants for patients randomized to implant therapy who were uninsured or otherwise unable to pay for implants, or who were located at a site where implants could not be purchased (e.g., the United Kingdom). Additional support was provided by Research to Prevent Blindness, Inc., New York, NY; the Paul and Evanina Mackall Foundation (Chicago, IL); and the Lois Pope Life Foundation (Delray Beach, FL). A representative of the National Eye Institute participated in the conduct of the study, including the study design; collection, management, analysis, and interpretation of the data; and review and approval of this manuscript. The sponsor or funding organization had no role in the design or conduct of this research.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - To assess the visual outcomes of cataract surgery in eyes that received fluocinolone acetonide implant or systemic therapy with oral corticosteroids and immunosuppression during the Multicenter Uveitis Steroid Treatment (MUST) Trial. Design Nested prospective cohort study of patients enrolled in a randomized clinical trial. Participants Patients that underwent cataract surgery during the first 2 years of follow-up in the MUST Trial. Methods Visual outcomes of cataract surgery were evaluated 3, 6, and 9 months after surgery using logarithmic visual acuity charts. Change in visual acuity over time was assessed using a mixed-effects model. Main Outcome Measures Best-corrected visual acuity. Results After excluding eyes that underwent cataract surgery simultaneously with implant surgery, among the 479 eyes in the MUST Trial, 117 eyes (28 eyes in the systemic, 89 in the implant group) in 82 patients underwent cataract surgery during the first 2 years of follow-up. Overall, visual acuity increased by 23 letters from the preoperative visit to the 3-month visit (95% confidence interval [CI], 17-29 letters; P < 0.001) and was stable through 9 months of follow-up. Eyes presumed to have a more severe cataract, as measured by inability to grade vitreous haze, gained an additional 42 letters (95% CI, 34-56 letters; P < 0.001) beyond the 13-letter gain in eyes that had gradable vitreous haze before surgery (95% CI, 9-18 letters; P < 0.001) 3 months after surgery, making up for an initial difference of-45 letters at the preoperative visit (95% CI,-56 to-34 letters; P < 0.001). Black race, longer time from uveitis onset, and hypotony were associated with worse preoperative visual acuity (P < 0.05), but did not affect postsurgical recovery (P > 0.05, test of interaction). After adjusting for other risk factors, there was no significant difference in the improvement in visual acuity between the 2 treatment groups (implant vs. systemic therapy, 2 letters; 95% CI,-10 to 15 letters; P = 0.70). Conclusions Cataract surgery resulted in substantial, sustained, and similar visual acuity improvement in the eyes of patients with uveitis treated with the fluocinolone acetonide implant or standard systemic therapy.
AB - To assess the visual outcomes of cataract surgery in eyes that received fluocinolone acetonide implant or systemic therapy with oral corticosteroids and immunosuppression during the Multicenter Uveitis Steroid Treatment (MUST) Trial. Design Nested prospective cohort study of patients enrolled in a randomized clinical trial. Participants Patients that underwent cataract surgery during the first 2 years of follow-up in the MUST Trial. Methods Visual outcomes of cataract surgery were evaluated 3, 6, and 9 months after surgery using logarithmic visual acuity charts. Change in visual acuity over time was assessed using a mixed-effects model. Main Outcome Measures Best-corrected visual acuity. Results After excluding eyes that underwent cataract surgery simultaneously with implant surgery, among the 479 eyes in the MUST Trial, 117 eyes (28 eyes in the systemic, 89 in the implant group) in 82 patients underwent cataract surgery during the first 2 years of follow-up. Overall, visual acuity increased by 23 letters from the preoperative visit to the 3-month visit (95% confidence interval [CI], 17-29 letters; P < 0.001) and was stable through 9 months of follow-up. Eyes presumed to have a more severe cataract, as measured by inability to grade vitreous haze, gained an additional 42 letters (95% CI, 34-56 letters; P < 0.001) beyond the 13-letter gain in eyes that had gradable vitreous haze before surgery (95% CI, 9-18 letters; P < 0.001) 3 months after surgery, making up for an initial difference of-45 letters at the preoperative visit (95% CI,-56 to-34 letters; P < 0.001). Black race, longer time from uveitis onset, and hypotony were associated with worse preoperative visual acuity (P < 0.05), but did not affect postsurgical recovery (P > 0.05, test of interaction). After adjusting for other risk factors, there was no significant difference in the improvement in visual acuity between the 2 treatment groups (implant vs. systemic therapy, 2 letters; 95% CI,-10 to 15 letters; P = 0.70). Conclusions Cataract surgery resulted in substantial, sustained, and similar visual acuity improvement in the eyes of patients with uveitis treated with the fluocinolone acetonide implant or standard systemic therapy.
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U2 - 10.1016/j.ophtha.2015.09.022
DO - 10.1016/j.ophtha.2015.09.022
M3 - Article
C2 - 26499920
AN - SCOPUS:84952994216
SN - 0161-6420
VL - 123
SP - 183
EP - 190
JO - Ophthalmology
JF - Ophthalmology
IS - 1
ER -