Author(s): Tomkins-Netzer O, Lightman SL, Burke AE, Sugar EA, Lim LL, Jaffe GJ, Altaweel MM, Kempen JH, Holbrook JT, Jabs DA; Multicenter Steroid Treatment (MUST) Trial and Follow-up Study Research Group. Seven-year outcomes of uveitic macular edema: the Multicenter Uveitis Steroid Treatment (MUST) trial and follow-up study results. Ophthalmology. 2020 Sep 9. pii: S0161-6420(20)30884-8. doi: 10.1016/j.ophtha.2020.08.035. [Epub ahead of print] PMID 32918964
Journal: Ophthalmology, Sep 2020
PURPOSE To evaluate the long-term outcomes of uveitic macular edema DESIGN: Longitudinal follow-up of a cohort of participants in a randomized clinical trial PARTICIPANTS: 248 eyes of 177 participants with uveitic macular edema enrolled in the Multicenter Uveitis Steroid Treatment Trial and Follow-up Study METHODS: Optical coherence tomography (OCT) measurements, taken at baseline and annually, were graded by reading-center graders masked to clinical data. Macular edema was defined as a center point macular thickness (CMT) >240 μm on time-domain OCT or time-domain OCT equivalent. Resolution of macular edema was defined as normalization of macular thickness on OCT. Relapse of macular edema was defined as increase in macular thickness to ≥240 μm in an eye that previously had resolution. Visual acuity was measured at each visit with logarithmic visual acuity charts.
MAIN OUTCOME MEASURES Resolution and relapse of macular edema. Visual acuity.
RESULTS Among 227 eyes with macular edema followed >1 year, the cumulative percent of eyes with macular edema resolving at any point during 7 years was 94% (95% confidence interval [CI]: 89%, 97%). Epiretinal membranes on OCT were associated with a lower likelihood of macular edema resolution (hazard ratio [HR] 0.74; 95% CI 0.55, 1.01; P=0.05). Among 177 eyes with resolved macular edema, the cumulative percent with relapse within 7 years was 43% (95% CI: 32%, 51%). Eyes in which macular edema resolved gained a mean of 6.24 letters (95% CI: 4.40, 8.09, P< 0.001) compared to eyes that remained free from macular edema during the 1-year follow-up intervals, whereas eyes where macular edema did not resolve experienced no gain in vision (mean change -1.30 letters; 95% CI: -2.70, 0.09, P=0.065), and eyes that developed macular edema during the year (either incident or relapsed) experienced a mean loss of -8.65 letters (95% CI: -11.5, -5.84, P< 0.001).
CONCLUSIONS Given sufficient time and treatment, nearly all uveitic macular edema resolves, but episodes of relapse were common. Visual acuity results were better among eyes with resolved macular edema, suggesting that control of inflammation and resolution of macular edema might be visually-relevant treatment targets.