Multifocal choroiditis with panuveitis incidence of ocular complications and of loss of visual acuity.
OBJECTIVE
To estimate the incidences of ocular complications and vision loss in patients with multifocal choroiditis with panuveitis (MFCPU) and to describe the association between therapy and the incidences thereof.


METHODS
Retrospective cohort study.


METHODS
Sixty-six patients (122 eyes) with MFCPU evaluated from January 1984 through June 2005 at a single-center academic practice.


METHODS
Demographic and clinical information on patients diagnosed with MFCPU was collected and entered into a computerized database for statistical analyses.


METHODS
Development of ocular complications, including choroidal neovascularization, epiretinal membrane, and cystoid macular edema (CME), and loss of visual acuity (VA) to 20/50 or worse and to 20/200 or worse.


RESULTS
Among affected eyes of patients with MFCPU, frequencies of VAs of 20/50 or worse and of 20/200 or worse at presentation were 55% and 38%, respectively. Choroidal neovascularization was observed in 22% of affected eyes at presentation and was the leading cause of poor VA at presentation. The incidence rates of vision loss to 20/50 or worse and to 20/200 or worse were 0.19/eye-year (EY) and 0.12/EY in affected eyes and 0.07/person-year (PY) and 0.04/PY in better-seeing eyes. Choroidal neovascularization was the most common cause of incident vision loss, with approximately 45% of incident vision loss attributed to new-onset or recurrent choroidal neovascularization. Presence of epiretinal membrane and CME also was associated with the development of vision loss during follow-up. When taken in combination, the incidence of any posterior pole complication was 0.13/EY in affected eyes. Use of immunosuppressive drug therapy (but not low-dose corticosteroid therapy) was associated with an 83% reduction in the risk of posterior pole complications (P = 0.004) and with a 92% reduction in the risk of 20/200 or worse VA in affected eyes (P = 0.05). Of the 6 eyes with recurrent choroidal neovascularization, only one recurrence was observed, in a patient receiving immunosuppressive drug therapy.


CONCLUSIONS
Treatment with immunosuppressive drugs may improve VA outcomes among patients with MFCPU by reducing the risk of sight-threatening posterior pole complications, including new-onset choroidal neovascularization and recurrent choroidal neovascularization among eyes with existing choroidal neovascularization.
Thorne
Jennifer E
JE
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA. jthorne@jhmi.edu
Wittenberg
Susan
S
Jabs
Douglas A
DA
Peters
George B
GB
Reed
Terry L
TL
Kedhar
Sanjay R
SR
Dunn
James P
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000209:etiology*; D002648:Child; D020256:Choroidal Neovascularization / Q000209:etiology* / Q000517:prevention & control; D002833:Choroiditis / Q000150:complications* / Q000188:drug therapy; D019773:Epiretinal Membrane / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008269:Macular Edema / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015864:Panuveitis / Q000150:complications* / Q000188:drug therapy; D012189:Retrospective Studies; D014792:Visual Acuity
D007166:Immunosuppressive Agents