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C. Hebson, D. Martin, S. Srivastava; Intraocular Pressure Response in Patients With Hypotony and Uveitis After Intravitreal Fluocinolone Acetonide Implantation (RetisertTM). Invest. Ophthalmol. Vis. Sci. 2009;50(13):3574.
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Uveitis is a potentially sight threatening disease that is secondary to both infectious and non-infectious etiologies. Hypotony is a well established complication of uveitis; and can result in corneal decompensation, accelerated cataract formation, and maculopathy. The RetisertTM implant is an approved treatment for chronic non-infectious uveitis. After RetisertTM implantation, 70% of patients experience a significant elevation in their intraocular pressure, with approximately 35-40% of patients requiring surgical intervention. Given this side effect, we examined the effect of RetisertTM implantation in our patients with both uveitis and hypotony.
A retrospective chart review was performed at Emory University to identify patients with uveitis and pre-operative hypotony who had undergone RetisertTM implantation. Patient demographics, eye(s) affected, surgery date, one, three, and six month pre-operative intraocular pressures, and post-operative intraocular pressures were recorded.
Seven eyes of 5 patients with pre-operative hypotony and RetisertTM implantation were identified. Five of 7 eyes continued to experience hypotony after RetisertTM implantation. Follow-up ranged from 6 weeks to 16 months. No eyes had active uveitis at follow-up. Two eyes of 2 patients had resolution of their hypotony within one month of surgery; although, one eye had borderline intraocular pressure (6 mmHg) after 6 months of follow-up. One eye of this group had a documented history of steroid response.
All patients had significant improvement in intraocular inflammation after RetisertTM implantation; however, hypotony persisted in the majority of eyes. In our patients, chronic hypotony did not respond to RetisertTM implantation, probably secondary to significant ciliary body damage from uveitis. Eyes that seemed to respond to RetisertTM implantation had a shorter history of hypotony and some steroid pressure response to intravitreal kenalog. Expeditious treatment remains the mainstay in preventing complications from chronic inflammation; as chronic hypotony remains challenging to manage and often irreversible.
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