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Jang won Heo, Bum-Joo cho, Afsheen Khwaja, Mohamed Ibrahim, Millena Bittencourt, Yasir Sepah, Srivastava Sunil, Albini Thomas, Quan D. Nguyen; Flucinolone Acetonide Implant (RETISERT) in the Management of Vogt-Koyanagi-Harada Disease. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2247.
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To evaluate the safety and efficacy of flucinolone acetonide (FA) intravitreal implant (RETISERT™) in chronic Vogt-Koyanagi-Harada (VKH) Disease
The index study was a subgroup analysis of a cohort of patients with chronic VKH disease from 3 prospective, dose-masked, randomized, 3-year historically controlled multicenter trials, in patients with noninfectious posterior or pan-uveitis. A total of 34 patients with chronic VKH randomized to receive either 0.59 mg or 2.1 mg implant were analyzed. The primary efficacy outcomes were recurrence rate and presence or absence of serous retinal detachment, anterior chamber cells and vitreous cells at various time points in implanted eyes compared to fellow eyes. Age, gender, race, changes of visual acuity, need for additional oral or locally injected corticosteroid and/or immunosuppressive agent, intraocular pressure, lens opacity, and other surgical complications were also assessed.
A total of 11 patients experienced at least one recurrence after FA implantation during the 3-year study period. There was a significant difference in the mean number of recurrences between implanted eyes (0.6 ± 1.0) and fellow eyes (3.1 ± 3.1). Visual acuity was stable or improved in 56% of implanted eyes. The percentage of patients who required systemic medication(s) was reduced from 82.3 %( 28/34) to 23.5 % (8/34), while the need for periocular injections was reduced from 32.4 % (11/34) to 20.5 % (7/34). Mean dosage of systemic corticosteroid was reduced from 10.6 mg/day to 2.3 mg/day; mean number of immunosuppressive agents was reduced from 0.6 to 0.1. 94% of phakic, implanted eyes (vs 52.9% of phakic fellow eyes) required cataract surgery and 47 % of all implanted eyes (vs 2.9% of fellow eyes) required intraocular pressure (IOP)-lowering surgery.
FA implant (RETISERT™) can provide control of inflammation and reduce dependency on systemic immunosuppression and/or corticosteroids in patients with chronic VKH. Eyes which have received FA implant are more likely to require surgical intervention for cataract and IOP control.
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