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Thomas H Dohlman, Sarju S Patel; Evaluation of the efficacy of the one-piece fluocinolone acetonide (Retisert™) implant in chronic posterior and panuveitis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1877.
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Posterior and pan-uveitis are vision-threating conditions that can be treated with intravitreal fluocinolone acetonide (Retisert™) implants. Recently, the implant was redesigned into a one-piece platform given complications of the two-piece implant over time. There is clinical suspicion that the one-piece design may be less efficacious in treatment compared to the two-piece design. Here we performed a retrospective case series evaluating the efficacy of one piece implants.
Eyes of patients with chronic posterior and pan-uveitis who received a one-piece fluocinolone acetonide implant (0.59 mg) were identified. To be included, the study eyes must have had at least 12 months of follow-up. Treatment efficacy was evaluated by assessing 1) the number of uveitis recurrences (defined according to published criteria by the SUN Working Group) and 2) the need for adjunctive therapy to control the uveitis. Percentages and proportions were calculated and compared to published data evaluating the original two-piece implant.
11 eyes of 6 patients were identified for inclusion. Zero eyes receiving the one-piece fluocinolone acetonide implant met the definition of a recurrence of uveitis. However, 6 eyes (55%) of 4 (66%) one-piece implant recipients required additional therapy (periocular injections and/or systemic therapy) to completely control the uveitis. 5 eyes (45%) of 3 (50%) implant recipients required adjunctive systemic therapy. These rates are considerably higher than previously published data on the original two-piece fluocinolone acetonide implant, in which 20% (MUST trial research group. Ophthalmology. 2015), 10.4% (Jaffe. Ophthalmology. 2011) and 13.9% (Sangwan Ophthalmol Ther. 2015) of two-piece implant recipients required systemic adjunctive therapy.
The one-piece fluocinolone acetonide implant, while highly active, may be less effective in treating chronic posterior and pan-uveitis when compared to the original two-piece design. This pilot study demonstrates a need for additional systemic anti-inflammatory therapy to fully control disease compared to previously published data. Larger studies are needed to evaluate this finding, as it may affect the use of the one-piece implant as a monotherapy and lower the threshold to employ additional anti-inflammatory therapy.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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