Treating patients with severe cases of uveitis, the fifth leading cause of vision loss in the United States, either locally with eye implants or systemically with anti-inflammatory medications improved vision similarly over two years, according to researchers. However, the risks of the two treatments and effects on inflammation were different, they found.
Uveitis is a collection of inflammatory diseases that produce damage to eye tissue. Severe forms of uveitis, such as intermediate, posterior, or panuveitis, affect the middle, back, or entire eye, respectively. Uveitis strikes at an earlier age than many other leading causes of vision loss, potentially leading to many years of disability.
The report, summarising results from the Multicenter Uveitis Steroid Treatment (MUST) Trial, was published online in Ophthalmology. The study was funded by the National Eye Institute, part of the National Institutes of Health (NIH).
Without aggressive treatment, the severe forms of uveitis often lead to vision loss. The conventional systemic treatment of chronically suppressing a patient’s entire immune system by giving them corticosteroid pills, sometimes along with other anti-inflammatory medicines, appears effective. However some eye care professionals are concerned that the treatment may lead to complications, such as increased blood pressure, diabetes, and osteoporosis.
In 2005, the U. S. Food and Drug Administration approved Retisert, a capsule surgically implanted in the eye that slowly releases corticosteroid medication, as a treatment for severe forms of uveitis. The goal of the MUST Trial was to compare the safety and effectiveness of local treatment with the Retisert implant versus conventional systemic therapy with oral medication.
The MUST Trial randomly assigned a treatment to 255 patients and then monitored their vision and health for the following two years. Patients treated with systemic drugs were usually given high doses of oral corticosteroids for one to four weeks, which then were reduced gradually to low doses, sometimes in combination with immunosuppressive drugs. For patients receiving local treatment, the Retisert implant was surgically inserted inside the affected eye.
After two years, the vision of patients receiving either treatment had improved similarly, gaining almost one line on an eye chart. Systemic treatment surprisingly produced few side effects. In contrast, the implant produced more eye problems, such as abnormally high eye pressure, glaucoma, and cataracts. These eye complications required additional treatment, sometimes including surgery. Although both treatments decreased inflammation in the eye, the implant did so faster and to a greater degree.
The MUST Trial results will guide doctors in their use of systemic corticosteroids to treat uveitis or other inflammatory diseases.