Predictors of visual outcomes in uveitic macular edema
Sophaktra Chea, MD
Sophaktra Chea1, Neil Onghanseng1, Muhammad Sohail Halim1, Jung Hyun Park1, Gunay Uludag1, Muhammad Hassan1, Rubbia Afridi1, Diana V. Do1, Quan Dong Nguyen1, Yasir J. Sepah1
1. Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Purpose: Using spectral domain optical coherence tomography (SD-OCT), we evaluate multiple prognostic factors to predict visual outcome in eyes with macular edema secondary to non-infectious uveitis (NIU).
- Methods: Post hoc analysis was performed on data from the STOP-Uveitis study, which was one year multicenter clinical trial that evaluated the use of two different doses of intravenous tocilizumab for the treatment of NIU. Subjects in the study with uveitic macular edema (UME) at any time in either one or both eyes were selected and analyzed. SD-OCT images from study visits when edema was present were manually segmented and compared to images either on edema resolution or to final study image in cases where edema persisted. Edema was sub-classified based on appearance to be either diffuse or cystoid. Images were screened for presence of specific lesions: center involving epiretinal membrane (ci-ERM), disorganization of the inner retinal layers (DRIL), center involving subretinal fluid (ci-SRF). Areas of blurring and/or frank deficit involving the external limiting membrane (ELM),inner and outer segment junction (IS/OS), and cone outer segment tips (COST) were identified and analyzed. Central retinal thickness (CRT) was also measured using two methods: standard method from internal limiting membrane to Bruch’s membrane and modified method from internal limiting membrane to retinal pigment epithelial layer. These factors were correlated to changes in best corrected visual acuity (BCVA) on corresponding visits.
- Results: We identified 34 eyes from 20 patients (11 females/55%) with UME. Mean age was 39.42±16.74 years. Mean duration of follow-up was 26.89 weeks. At baseline, mean BCVA was 71.94 ±14.32 ETDRS letter, CRT (374.88±165.80 µm) and modified CRT (360.71±167.43 µm). Mean BCVA was 76.97±12.81 ETDRS letter, CRT (299.47±41.61 µm), modified CRT (283.62±41.78 µm) at the last study visit. Table 1 lists various retinal layer defects at baseline and last visit.
- The mean BCVA change was 5.03±13.9. Patients with DRIL had lower baseline BCVA but showed significant improvement during the study (P: 0.019) [Table 2]. Apparent structural improvement in IS/OS disruption was significant but did not lead to corresponding improvement in BCVA.
- Conclusion: In STOP-Uveitis, treatment with intravenous tocilizumab led to improvement of DRIL (and corresponding gain in BCVA) and restoration of IS/OS junction in patients with UME.