title: Incidence of visual improvement in uveitis cases with visual impairment caused by macular edema.
abstract: OBJECTIVE
  Among cases of visually significant uveitic macular edema (ME), to estimate the incidence of visual improvement and identify predictive factors.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  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).
  
  
  METHODS
  Data were obtained by standardized chart review.
  
  
  METHODS
  Decrease of ≥ 0.2 base 10 logarithm of visual acuity decimal fraction-equivalent; risk factors for such visual improvement.
  
  
  RESULTS
  We identified 1510 eyes (of 1077 patients) with visual impairment to a level <20/40 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 (P <0.001 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.
  
  
  CONCLUSIONS
  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.
authors: Department of Ophthalmology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Marc H
authors: MH
authors: Levin
authors: Department of Ophthalmology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Maxwell
authors: M
authors: Pistilli
authors: Department of Ophthalmology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Ebenezer
authors: E
authors: Daniel
authors: The Fundus Photograph Reading Center, Department of Ophthalmology, the University of Wisconsin School of Medicine, Madison, Wisconsin.
authors: Sapna S
authors: SS
authors: Gangaputra
authors: Laboratory of Immunology, National Eye Institute, Bethesda, Maryland.
authors: Robert B
authors: RB
authors: Nussenblatt
authors: Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Department of Medicine, Oregon Health & Science University, Portland, Oregon.
authors: James T
authors: JT
authors: Rosenbaum
authors: Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Portland Veterans' Affairs Medical Center, Portland, Oregon.
authors: Eric B
authors: EB
authors: Suhler
authors: Department of Ophthalmology, the Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors: Jennifer E
authors: JE
authors: Thorne
authors: The Massachusetts Eye Research and Surgery Institute, Cambridge, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors: C Stephen
authors: CS
authors: Foster
authors: Department of Epidemiology, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Departments of Ophthalmology and Medicine, the Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Douglas A
authors: DA
authors: Jabs
authors: Laboratory of Immunology, National Eye Institute, Bethesda, Maryland.
authors: Grace A
authors: GA
authors: Levy-Clarke
authors: Department of Ophthalmology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics & Epidemiology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, the Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: john.kempen@uphs.upenn.edu.
authors: John H
authors: JH
authors: Kempen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005451:Fluorescein Angiography; D015796:HLA-B27 Antigen / Q000097:blood; D006801:Humans; D015994:Incidence; D008269:Macular Edema / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014605:Uveitis / Q000209:etiology / Q000503:physiopathology*; D015354:Vision, Low / Q000209:etiology / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult
chemical_list: D015796:HLA-B27 Antigen