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David Allen DiLoreto, Zoë Williams, Yousuf M Khalifa; Autoimmune Retinopathy Treated with the Fluocinolone Acetonide Intravitreal Implant After Intolerance to Systemic Immunosuppression. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2517.
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© ARVO (1962-2015); The Authors (2016-present)
To report outcomes of two cases of autoimmune retinopathy (AIR), one cancer associated retinopathy (CAR) and one non-paraneoplastic autoimmune retinopathy (npAIR), treated locally with the fluocinolone acetonide intravitreal implant (Retisert) due to intolerance to systemic immunosuppression
Case 1. A 64 year old male with CAR secondary to poorly differentiated carcinoma of the lung (confirmed with markedly diminished full-field ERG and anti-retinal autoantibody testing positive for antibodies against 30-kDA (carbonic anhydrase II), 36-kDa (GAPDH), 40-kDa (aldolase), 45-kDa (arrestin) and 62-kDa proteins) was treated with a sustained release intravitreal steroid implant (fluocinolone acetonide 0.59mg (Retisert)) after progressive vision loss despite intravenous immunoglobulin therapy. He was unable to tolerate systemic immunosuppression with mycophenolate mofetil due to leucopenia and developed multiple adverse side effects from high dose prednisone. His vision was successfully stabilized with a sustained release intravitreal fluocinolone acetonide implant alone for 6 months prior to his death. Case 2. An 87 year old male with a 10-year history of chronic bilateral uveitis, severe arteriolar attenuation and bilateral visual field constriction was diagnosed with npAIR (antiretinal antibody testing pending) after work-up failed to reveal cancer. Optical coherence tomography scan revealed diffuse thinning of the retina with limited sparing of the inner segment/outer segment junction in the central macula. He had been treated previously with topical and subtenon's steroids with limited response. Intravitreal steroid injections stablilized the disease for limited duration. Treatment with mycophenolate mofetil was not tolerated and he deferred trial of other immunosuppressive agents. Bilateral intravitreal fluocinolone acetonide implants were used to stabilize his disease at 20/150 in both eyes with more than one year of follow-up.
Local ocular treatment with steroids is an option in patients with autoimmune retinopathy when systemic immunosuppresion fails or is not tolerated. We report the first use of intravitreal steroids in sustained release form to treat autoimmune retinopathy without concomitant use of systemic immunosuppression.
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