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Cataract Surgery Outcomes in Uveitis: The Multicenter Uveitis Steroid Treatment Trial.

Abstract：

PURPOSE: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.

journal_name

Ophthalmology

journal_title

Ophthalmology

authors

Sen HN,Abreu FM,Louis TA,Sugar EA,Altaweel MM,Elner SG,Holbrook JT,Jabs DA,Kim RY,Kempen JH,Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study Research Group.

doi

10.1016/j.ophtha.2015.09.022

subject

Has Abstract

pub_date

2016-01-01 00:00:00

pages

183-90

issue

eissn

0161-6420

issn

1549-4713

pii

S0161-6420(15)01050-7

journal_volume

123

pub_type

杂志文章,多中心研究,随机对照试验

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Cataract Surgery Outcomes in Uveitis: The Multicenter Uveitis Steroid Treatment Trial.