Back to Search Start Over

Incidence of Visual Improvement in Uveitis Cases with Visual Impairment Caused by Macular Edema

Authors :
Eric B. Suhler
Grace A. Levy-Clarke
Jennifer E. Thorne
John H. Kempen
C. Stephen Foster
Maxwell Pistilli
Robert B. Nussenblatt
Ebenezer Daniel
Douglas A. Jabs
Marc H. Levin
James T. Rosenbaum
Sapna Gangaputra
Source :
Ophthalmology. 121:588-595.e1
Publication Year :
2014
Publisher :
Elsevier BV, 2014.

Abstract

Among cases of visually significant uveitic macular edema (ME), to estimate the incidence of visual improvement and identify predictive factors.Retrospective cohort study.Eyes with uveitis, seen at 5 academic ocular inflammation centers in the United States, for which ME was documented to be currently present and the principal cause of reduced visual acuity (20/40).Data were obtained by standardized chart review.Decrease of ≥ 0.2 base 10 logarithm of visual acuity decimal fraction-equivalent; risk factors for such visual improvement.We identified 1510 eyes (of 1077 patients) with visual impairment to a level20/40 attributed to ME. Most patients were female (67%) and white (76%), and had bilateral uveitis (82%). The estimated 6-month incidence of ≥ 2 lines of visual acuity improvement in affected eyes was 52% (95% confidence interval [CI], 49%-55%). Vision reduced by ME was more likely to improve by 2 lines in eyes initially with poor visual acuity (≤ 20/200; adjusted hazard ratio [HR] 1.5; 95% CI, 1.3-1.7), active uveitis (HR, 1.3; 95% CI, 1.1-1.5), and anterior uveitis as opposed to intermediate (HR, 1.2), posterior (HR, 1.3), or panuveitis (HR, 1.4; overall P = 0.02). During follow-up, reductions in anterior chamber or vitreous cellular activity or in vitreous haze each led to significant improvements in visual outcome (P0.001 for each). Conversely, snowbanking (HR, 0.7; 95% CI, 0.4-0.99), posterior synechiae (HR, 0.8; 95% CI, 0.6-0.9), and hypotony (HR, 0.2; 95% CI, 0.06-0.5) each were associated with lower incidence of visual improvement with respect to eyes lacking each of these attributes at a given visit.These results suggest that many, but not all, patients with ME causing low vision in a tertiary care setting will enjoy meaningful visual recovery in response to treatment. Evidence of significant ocular damage from inflammation (posterior synechiae and hypotony) portends a lower incidence of visual recovery. Better control of anterior chamber or vitreous activity is associated with a greater incidence of visual improvement, supporting an aggressive anti-inflammatory treatment approach for ME cases with active inflammation.

Details

ISSN :
01616420
Volume :
121
Database :
OpenAIRE
Journal :
Ophthalmology
Accession number :
edsair.doi.dedup.....8d23d0a19f112fb9b63719acb2360308
Full Text :
https://doi.org/10.1016/j.ophtha.2013.09.023