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


METHODS
Nested prospective cohort study of patients enrolled in a randomized clinical trial.


METHODS
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.


METHODS
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.
National Eye Institute, National Institutes of Health, Bethesda, Maryland. Electronic address: senh@nei.nih.gov.
H Nida
HN
Sen
Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Francis M
FM
Abreu
Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Thomas A
TA
Louis
Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Elizabeth A
EA
Sugar
Department of Ophthalmology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Michael M
MM
Altaweel
Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
Susan G
SG
Elner
Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Janet T
JT
Holbrook
Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Departments of Ophthalmology and Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Douglas A
DA
Jabs
Retina Consultants of Houston, Houston, Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; and the Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
Rosa Y
RY
Kim
Department of Ophthalmology and the Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
John H
JH
Kempen
D000328:Adult; D002386:Cataract / Q000150:complications*; D002387:Cataract Extraction / Q000379:methods*; D004343:Drug Implants; D005260:Female; D005446:Fluocinolone Acetonide / Q000008:administration & dosage*; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014605:Uveitis / Q000150:complications* / Q000188:drug therapy; D014792:Visual Acuity
D004343:Drug Implants; D005938:Glucocorticoids; D005446:Fluocinolone Acetonide