Morphological assessment of the retina in uveitis.
BACKGROUND
The objective of this study is to describe a system for color photograph evaluation in uveitis and report baseline morphologic findings for the Multicenter Uveitis Steroid Treatment (MUST) Trial. Four-hundred seventy-nine eyes of 255 subjects with intermediate, posterior, and panuveitis had stereoscopic color fundus photographs obtained by certified photographers and evaluated by certified graders using standardized procedures to evaluate morphologic characteristics of uveitis. The posterior pole was evaluated for macular edema, vitreoretinal interface abnormalities, and macular pigment disturbance/atrophy; the optic disk was assessed for edema, pallor, or glaucomatous changes. The presence of neovascularization, vascular occlusion, vascular sheathing, and tractional retinal changes was determined. A random subset of 77 images was re-graded to determine the percentage agreement with the original grading on a categorical scale.


RESULTS
At baseline, 437/479 eyes had images available to grade. Fifty-three eyes were completely ungradable due to media opacity. Common features of intermediate and posterior/panuveitis were epiretinal membrane (134 eyes, 35 %), and chorioretinal lesions (140 eyes, 36 %). Macular edema was seen in 16 %. Optic nerve head and vascular abnormalities were rare. Reproducibility evaluation found exact agreement for the presence of chorioretinal lesions was 78 %, the presence and location of macular edema was 71 %, and the presence of epiretinal membrane was 71 %. Vertical cup-to-disk ratio measurement had intra-class correlation of 0.75.


CONCLUSIONS
The MUST system for evaluating stereoscopic color fundus photographs describes the morphology of uveitis and its sequelae, in a standardized manner, is highly reproducible, and allows monitoring of treatment effect and safety evaluation regarding these outcomes in clinical trials.
Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, USA. mmaltaweel@wisc.edu.|Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 2870 University Ave. Suite 206, Madison, WI, 53705, USA. mmaltaweel@wisc.edu.
Michael M
MM
Altaweel
Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, USA.
Sapna S
SS
Gangaputra
Department of Ophthalmology, The Johns Hopkins University, Baltimore, MD, USA.|Department of Epidemiology, The Johns Hopkins University, Baltimore, MD, USA.
Jennifer E
JE
Thorne
Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA.
James P
JP
Dunn
Kellogg Eye Center, Ann Arbor, MI, USA.
Susan G
SG
Elner
Duke Eye Center, Durham, NC, USA.
Glenn J
GJ
Jaffe
Retina Consultants of Houston, Houston, TX, USA.
Rosa Y
RY
Kim
Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, MO, USA.
P Kumar
PK
Rao
Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, USA.
Susan B
SB
Reed
Departments of Ophthalmology and Biostatistics & Epidemiology and the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA.
John H
JH
Kempen