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J.P. Denny, A. Carlson, R. McCallum, P. Ashton, B. Branchaud, G.J. Jaffe; Combined Fluocinolone Acetonide Sustained Drug Delivery System Implantation and Phacoemulsification/Intraocular Lens Implantation in Patients with Severe Uveitis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2410.
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Purpose: Cataracts are common in eyes with uveitis. Postoperative inflammation may complicate cataract extraction in these eyes. In this pilot study, we determined whether a 3-year fluocinolone acetonide sustained drug delivery system (FA) safely suppressed postoperative inflammation when combined with phacoemulsification and posterior chamber intraocular lens implantation (phaco/PCIOL) in eyes with severe uveitis. Methods: Eight eyes of 7 patients with posterior- or pan-uveitis requiring immunosuppressive therapy and/or periocular corticosteroid injections underwent simultaneous FA implantation (0.5mg or 2mg) and phaco/PCIOL. Patients were followed-up at regular intervals and visual acuity (VA), intraocular pressure (IOP), operative complications, level of inflammation and anti-inflammatory medications were recorded. Preoperative and postoperative data were compared using a paired t-test. Results: The mean postoperative follow-up was 58 weeks (range: 8-155). None of the patients had intraoperative complications. The mean preoperative LogMar VA was 1.6 (Snellen equivalent [SE] = 20/750). The mean postoperative VA was 0.54 (SE = 20/70; p<0.02). Seven of the 8 eyes improved 4 or more lines. Five of 8 eyes had a final VA of 20/40 or better. Intraocular inflammation did not recur in any eye receiving FA implantation. In all patients who preoperatively required systemic immunosuppression, the immunosuppressive agents were reduced postoperatively. Preoperatively, patients used an average of 7.4 steroid drops per day (range: 0 - 16). Postoperatively, the mean number of drops per day was 1.5 (range: 0 - 4, p<0.05). Ten periocular corticosteroid injections were given in the preoperative period (i.e. the same number of weeks as the postoperative follow-up) as compared to 1 injection given postoperatively. The mean preoperative IOP was 12 (range: 7 - 17). The mean postoperative IOP was 17 (range 5 - 44). Two of the 7 patients required IOP lowering medications. Conclusions: FA implantation and phaco/PCIOL can be combined safely in patients with severe uveitis. FA implantation effectively controls inflammation over an extended period of time in a complicated group of patients with posterior and/or panuveitis and allows reduced immunosuppression. Increased IOP appears to be the most significant risk. This device is a promising adjunctive therapy for patients with severe uveitis and cataract.
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