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Eun kyu Oh, Hyeong Gon Yu; Long-term results of fluocinolone acetonide intravitreal implant in Behcet's patients with intractable posterior uveitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2934.
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To evaluate the long-term efficacy and safety of the flucinolone acetonide intravitreal implant in Behcet's disease patients with intractable noninfectious posterior uveitis
Behcet's patients with intractable posterior uveitis, which failed to respond to conventional treatment with topical and systemic steroids and/or systemic steroid-sparing agents were treated with a fluocinolone acetonide intravitreal implant of 0.59mg. Snellen visual acuity, control of inflammation, and the development of complications such as infection or uncontrollable intraocular pressure were evaluated.
Eight eyes of 7 patients were included. Mean age at implant placement was 35.3 years (range, 17-42 years). Two eyes were pseudophakic at the time of surgery, and 5 eyes had cataract operation at the time of surgery. Mean follow-up duration was 43.5 months (range, 12-57.6 months). Postoperative visual acuity improved over 3 lines in 5 eyes (62.5%). Inflammation was well controlled postoperatively in all study eyes, with decreased medication for inflammatory control in all patients. 3 patients were able to discontinue all systemic medications, 2 others were able to decrease to less than 10mg of steroid, but the other 3 patients required systemic medications due to inflammation in the fellow eye. During the follow up period, the mean number of recurrence of uveitis was 0.33 in the implanted eye and 1.5 in the fellow eye. Six eyes (75%) had postoperative intraocular pressure spikes over 30 mmHg, two eyes (25%) having over 40 mmHg despite medication. All patients required glaucoma shunting surgery postoperatively for intraocular pressure control. No recurrence of inflammation after implant surgery was observed in any of the patients. The single phakic eye developed a visually significant posterior subcapsular lens opacification requiring cataract extraction. There was one case of postoperative cytomegalovirus endothelitis, resuting in corneal endothelial decompensation. Infection was controled with oral valganciclovir and the patient did not require implant removal. There were no postoperative wound leakage or implant dislocation.
The fluocinolone implant was effective in the control of intractable inflammation of Behcet's uveitis. Elevation of IOP still remains a major potential complication, and the possibility of infection should also be considered.
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