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Thomas Albini, Debra Goldstein, David Callanan, Quan Dong Nguyen, Sunil Srivastava; Visual outcomes in uveitis with angiographic macular leakage treated with the fluocinolone acetonide implant or standard treatment. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5933.
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Macular leakage associated with cystoid macular edema is a common cause of severe vision loss in patients with uveitis. This study examines the visual acuity outcomes of eyes treated with implant as compared to fellow eyes or those treated with standard of care.
Patients with macular leakage at baseline were identified from three prospective, randomized clinical trials examining the use of fluocinolone acetonide in the treatment of non-infectious posterior uveitis. Fluorescein angiograms were performed on each patient at regular time points. A centralized reading center analyzed and graded each angiogram. Visual outcomes were examined and analyzed at baseline and the two year time point. Three specific treatment groups were identified and analyzed - those eyes treated with the fluocinolone acetonide implant (IMP), fellow eyes (FEL) of patients with implants and eyes treated with standard of care systemic (SOC) medications.
A total of 250 eyes treated with the IMP device had macular leakage identified at baseline. In comparision, 163 FEL eyes and 59 SOC eyes had baseline macular leakage. The mean baseline logMAR visual acuity was significantly worse in IMP and FEL eyes (.56 in both) vs SOC eyes (.39), (p<.01). IMP eyes had a significantly greater improvement of vision over 24 months (.56 to .41) in comparision to both SOC eyes (.39 to .40) and FEL eyes (.56 to .64), (p<.01). In eyes without evidence of macular leakage at baseline, all groups had some improvement of vision over 24 months: IMP (.41 to .33), FEL (.28 to .24) and SOC (.12 to .09). The amount of improvement was not statistically different between these groups.
In eyes with fluorescein evidence of macular leakage, fluocinolone acetonide device resulted in a statistically significant greater improvement in visual acuity over 24 months vs FEL eyes and SOC eyes. In eyes with macular leakage, the fluocinolone acetonide device may offer superior improvement of visual acuity over 2 years in comparison to eyes treated with standard of care therapy.
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