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Harpal Sandhu, Parvathy Pillai, George Papaliodis; Fluocinolone Acetonide Implants for Refractory Uveitis: a Retrospective Review. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5197.
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To assess the efficacy and adverse effects of fluocinolone acetonide intravitreal implants for use in refractory uveitis.
A retrospective case series of patients from the Uveitis and Ocular Immunology Service at the Massachusetts Eye and Ear Infirmary who have had fluocinolone acetonide implants placed.
Eighteen eyes in 13 patients between 2009 and 2012 underwent surgery for intravitreal insertion of the fluocinolone acetonide drug-eluting implant, 13 eyes of which had at least 12 months of follow up and five of which at least six months. Three patients carried a diagnosis of idiopathic panuveitis, three of sarcoidosis, three of Vogt-Koyanagi-Harada Syndrome, one of idiopathic retinal vasculitis, one of juvenile idiopathic arthritis, one of birdshot chorioretinopathy, one of sympathetic ophthalmia, and one of HLA-B27-associated uveitis. Mean logMAR visual acuity improved from 1.31 preoperatively to 0.84 (p = 0.008) and 0.82 (p = 0.009) at 6 and 12 months, respectively. Preoperatively, 13 eyes required systemic immunosuppression for inflammatory disease limited to the eye compared with five at 12 months postoperatively. Preoperatively, nine eyes were on glaucoma therapy compared with 12 at 12 months, six of which underwent glaucoma filtering surgery. Mean intraocular pressure preoperatively was 18.1. Postoperatively the mean IOP was 18.2 at 12 months (p = 0.96). All phakic patients underwent cataract extraction over the course of follow up. Four patients had vitreous hemorrhage within a month of surgery, all of which cleared without intervention.
Fluocinolone acetonide implants significantly improved visual acuity at six months and 12 months postoperatively. For patients without systemic manifestations of inflammatory disease, systemic immunosuppressive medications were reduced at six and 12 months. Most patients required new or more intensive surgical or medical treatment of intraocular pressure as well as cataract extraction.
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