Multifocal Choroiditis with Panuveitis: Incidence of Ocular Complications and of Loss of Visual Acuity
Received 12 March 2006; accepted 21 May 2006. published online 21 September 2006.
Purpose
To estimate the incidences of ocular complications and vision loss in patients with multifocal choroiditis with panuveitis (MFCPU) and to describe the association between therapy and the incidences thereof.
Design
Retrospective cohort study.
Participants
Sixty-six patients (122 eyes) with MFCPU evaluated from January 1984 through June 2005 at a single-center academic practice.
Methods
Demographic and clinical information on patients diagnosed with MFCPU was collected and entered into a computerized database for statistical analyses.
Main Outcome Measures
Development of ocular complications, including choroidal neovascularization, epiretinal membrane, and cystoid macular edema (CME), and loss of visual acuity (VA) to 20/50 or worse and to 20/200 or worse.
Results
Among affected eyes of patients with MFCPU, frequencies of VAs of 20/50 or worse and of 20/200 or worse at presentation were 55% and 38%, respectively. Choroidal neovascularization was observed in 22% of affected eyes at presentation and was the leading cause of poor VA at presentation. The incidence rates of vision loss to 20/50 or worse and to 20/200 or worse were 0.19/eye-year (EY) and 0.12/EY in affected eyes and 0.07/person-year (PY) and 0.04/PY in better-seeing eyes. Choroidal neovascularization was the most common cause of incident vision loss, with approximately 45% of incident vision loss attributed to new-onset or recurrent choroidal neovascularization. Presence of epiretinal membrane and CME also was associated with the development of vision loss during follow-up. When taken in combination, the incidence of any posterior pole complication was 0.13/EY in affected eyes. Use of immunosuppressive drug therapy (but not low-dose corticosteroid therapy) was associated with an 83% reduction in the risk of posterior pole complications (P = 0.004) and with a 92% reduction in the risk of 20/200 or worse VA in affected eyes (P = 0.05). Of the 6 eyes with recurrent choroidal neovascularization, only one recurrence was observed, in a patient receiving immunosuppressive drug therapy.
Conclusions
Treatment with immunosuppressive drugs may improve VA outcomes among patients with MFCPU by reducing the risk of sight-threatening posterior pole complications, including new-onset choroidal neovascularization and recurrent choroidal neovascularization among eyes with existing choroidal neovascularization.
1Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
2Department of Epidemiology, Center for Clinical Trials, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
3Department of Ophthalmology, University of Texas, Houston, Texas.
4Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Correspondence to Jennifer E. Thorne, MD, PhD, Wilmer Eye Institute, 550 North Broadway, Suite 700, Baltimore, MD 21205.
Manuscript no. 2006-311.
Supported by the National Eye Institute, Bethesda, Maryland (grant nos.: EY-13707 [JET], EY-00405 [DAJ]).
ABSTRACT