Implant slightly better than systemic therapy in noninfectious uveitis
Fluocinolone acetonide implant and systemic corticosteroid therapy both improve vision-related quality of life (VRQoL) in patients with noninfectious uveitis, according to a study. However, the implant group shows an immediate improvement as compared to gradual for the systemic group.
Researchers evaluated semiannually data from the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) for the first 3 years after randomization. Participants involved patients with active or recently active intermediate uveitis, posterior uveitis or panuveitis enrolled in the Multicenter Steroid Treatment Trial and Follow-up Study.
Due to significant differences in the trajectories of VRQoL, analyses were stratified by assigned treatment (129 implants vs 126 systemic therapies). Generalized estimating equations were used to assess the impact of baseline measurements of visual function (visual acuity and visual field), demographics and disease characteristics.
After 3 years of follow-up, improvement in NEI-VFQ-25 scores was similar among participants in the implant group (11.9 points; 95 percent CI, 8.6 to 15.2; p<0.001) and the systemic group (9.0 points; 5.6 to 12.3; p<0.001; p=0.21 for interaction). Those in the implant group had a significant improvement during the first 6 months followed by stable scores. On the other hand, patients in the systemic group had a steady improvement over the course of follow-up.
Lower initial NEI-VFQ-25 scores correlated with worse initial visual acuity and visual fields for both treatment groups. Such differences persisted throughout follow-up among patients in the systemic group.
In the implant group, those with initial visual acuity worse than 20/40 showed further improvement in NEI-VFQ-25 score to come within ‒7 points (‒15.0 to 0.9) of those with visual acuity 20/40 or better initially. Such difference is clinically meaningful but not statistically significant (p=0.081). Furthermore, there were similar patterns in the results based on sensitivity analyses.
“Poorer visual function was associated significantly with initial differences in NEI-VFQ-25 scores. However, only individuals in the implant group with poor visual acuity were able to overcome their initial deficits by the end of 3 years,” researchers said.