Incidence and Outcome of Uveitic Glaucoma in Eyes With Intermediate, Posterior, or Panuveitis Followed up to 10 Years After Randomization to Fluocinolone Acetonide Implant or Systemic Therapy.
Kempen John H, Van Natta Mark L, Friedman David S, Altaweel Michael M, Ansari Husam, Dunn James P, Elner Susan G, Holbrook Janet T, Lim Lyndell L, Sugar Elizabeth A
AI Summary
This study found fluocinolone implants cause substantially higher glaucoma risk than systemic therapy in uveitis patients. Careful, indefinite IOP monitoring is crucial, as some glaucoma worsened despite expert management.
Abstract
Purpose
To evaluate long-term risk and outcomes of glaucoma in eyes with intermediate, posterior, and panuveitis managed with systemic or fluocinolone acetonide (0.59 mg, "implant") therapy.
Design
Prospective Follow-up of the Multicenter Uveitis Steroid Treatment (MUST) Clinical Trial Cohort.
Methods
Patients with intermediate, posterior, or panuveitis randomized to implant or systemic therapy (corticosteroid plus immunosuppression in >90%) were followed prospectively for glaucoma incidence and outcome.
Results
Among 405 uveitic at-risk eyes of 232 patients (median follow-up = 6.9 years), 40% (79/196) of eyes assigned and treated with implant and 8% (17/209) of eyes assigned and treated with systemic therapy (censoring eyes receiving an implant on implantation) developed glaucoma (hazard ratio [HR] = 5.9, 95% confidence interval [CI] 3.2, 10.8; P < .001). Adjustment for intraocular pressure (IOP) elevation during follow-up only partially mitigated the association of implant treatment with glaucoma incidence: HR = 3.1 (95% CI 1.6, 6.0); P = .001. Among 112 eyes of 83 patients developing glaucoma, the 5-year cumulative incidence following diagnosis of sustained (2 or more consecutive visits) worsening of mean deviation by ≥6 dB was 20% (95% CI 12%, 33%); 5-year cumulative incidence of sustained worsening of cup-to-disc ratio by ≥0.2 was 26% (95% CI 17%, 39%).
Conclusions
The implant has substantially higher risk of glaucoma than systemic therapy, a difference not entirely explained by posttreatment IOP elevation. Management of IOP elevation was effective in preventing worsening of glaucoma for the large majority of cases, but even under expert clinical management, some glaucoma worsened. Uveitis cases should be monitored carefully for IOP elevation and glaucoma indefinitely.
MeSH Terms
Shields Classification
Key Concepts5
Among 405 uveitic at-risk eyes of 232 patients (median follow-up = 6.9 years), 40% (79/196) of eyes assigned and treated with fluocinolone acetonide (0.59 mg, "implant") developed glaucoma, compared to 8% (17/209) of eyes assigned and treated with systemic therapy (corticosteroid plus immunosuppression in >90%), with a hazard ratio (HR) = 5.9 (95% confidence interval [CI] 3.2, 10.8; P < .001).
Adjustment for intraocular pressure (IOP) elevation during follow-up only partially mitigated the association of fluocinolone acetonide (0.59 mg, "implant") treatment with glaucoma incidence (HR = 3.1, 95% CI 1.6, 6.0; P = .001) in eyes with intermediate, posterior, or panuveitis.
Among 112 eyes of 83 patients developing uveitic glaucoma, the 5-year cumulative incidence following diagnosis of sustained (2 or more consecutive visits) worsening of mean deviation by ≥6 dB was 20% (95% CI 12%, 33%).
Among 112 eyes of 83 patients developing uveitic glaucoma, the 5-year cumulative incidence of sustained worsening of cup-to-disc ratio by ≥0.2 was 26% (95% CI 17%, 39%).
Management of intraocular pressure (IOP) elevation was effective in preventing worsening of glaucoma for the large majority of uveitic glaucoma cases, but even under expert clinical management, some glaucoma worsened.
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