title: Outcome of Treatment of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial 2-Year Results.
abstract: OBJECTIVE
  To evaluate the 2-year outcomes of uveitic macular edema.
  
  
  METHODS
  Longitudinal follow-up of a randomized cohort.
  
  
  METHODS
  At baseline, 148 eyes of 117 patients enrolled in the Multicenter Uveitis Steroid Treatment (MUST) Trial had macular edema, and 134 eyes of 108 patients completed 2-year follow-up.
  
  
  METHODS
  Patients enrolled in the study were randomized to either systemic immunosuppression or intravitreal fluocinolone acetonide implant therapy. Macular edema was defined as thickening of the retina (center point thickness≥240 μm) on time-domain optical coherence tomography (OCT) of macula.
  
  
  METHODS
  Improvement in macular edema (≥20% reduction in central point thickness on OCT), resolution of macular edema (normalization of thickness on OCT), and best-corrected visual acuity (BCVA).
  
  
  RESULTS
  Between randomization and 2-years' follow-up, 62% and 25% of eyes in the systemic and implant groups, respectively, received at least 1 supplemental regional corticosteroid injection. By 2-years' follow-up, macular edema improved in 71% of eyes and resolved in 60%. There were no differences between treatment groups in the proportion of eyes with macular edema improving (systemic therapy vs. implant, 65% vs. 77%; P=0.20) and resolving (52% vs. 68%; P=0.28), but eyes randomized to implant had more improvement in macular thickness (median decrease of 180 vs. 109 μm in the systemic therapy group; P=0.04). Eyes with baseline fluorescein angiographic leakage were more likely to improve than those without (76% vs. 58%; P=0.03). Overall, there was a mean 5-letter (1 line) improvement in BCVA at 2 years. Mean changes in BCVA from baseline at 2 years by macular edema response status were: resolution, +10 letters; improvement without resolution, +10 letters (P=0.92); little to no change, 6 letters (P=0.19); and worsening, -16 letters (worsening acuity; P=0.0003).
  
  
  CONCLUSIONS
  About two thirds of eyes with uveitic macular edema were observed to experience improvement in the edema and visual acuity with implant or systemic treatment. Fluocinolone acetonide implant therapy was associated with a greater quantitative improvement in thickness. Fluorescein angiography leakage was associated with a greater likelihood of improvement in macular edema.
authors.affiliation: The Institute of Ophthalmology, University College London, London, United Kingdom.
authors.forename: Oren
authors.initials: O
authors.lastname: Tomkins-Netzer
authors.affiliation: The Institute of Ophthalmology, University College London, London, United Kingdom.
authors.forename: Susan
authors.initials: S
authors.lastname: Lightman
authors.affiliation: Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Lea
authors.initials: L
authors.lastname: Drye
authors.affiliation: The Departments of Ophthalmology and Epidemiology, the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Kempen
authors.affiliation: UCLA Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California.
authors.forename: Gary N
authors.initials: GN
authors.lastname: Holland
authors.affiliation: Department of Ophthalmology, USC Eye Institute, University of Southern California, Los Angeles, California.
authors.forename: Narsing A
authors.initials: NA
authors.lastname: Rao
authors.affiliation: Department of Ophthalmology, Royal Victorian Eye & Ear Hospital, East Melbourne, Australia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Stawell
authors.affiliation: Department of Ophthalmology, University of Utah, Salt Lake City, Utah.
authors.forename: Albert
authors.initials: A
authors.lastname: Vitale
authors.affiliation: 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. Electronic address: douglas.jabs@mssm.edu.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D004343:Drug Implants; D005260:Female; D005446:Fluocinolone Acetonide / Q000008:administration & dosage*; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage*; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014605:Uveitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D004343:Drug Implants; D005938:Glucocorticoids; D005446:Fluocinolone Acetonide; D011239:Prednisolone