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Amina Chaudhry, Yosuke Harada, Debra A Goldstein; Spontaneous separation of fluocinolone acetonide implant. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3111.
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Retisert (Bausch & Lomb, Rochester, NY) is a long-acting sutured fluocinolone acetonide intravitreal implant (FAI) approved for treatment of chronic non-infectious uveitis. Complications include increased intraocular pressure, cataract, intraocular hemorrhage, endophthalmitis. Separation of drug pellet from sutured strut has been reported during surgical manipulation (1) and, rarely, spontaneously; typically 3 - 7 years after placement (2,3). We report a series of patients with very late spontaneous FAI strut-pellet separation.
Chart review of patients with FAI separation diagnosed by the uveitis service at Northwestern University July 2012 - September 2014. Data collected included patient demographics, ocular surgical history, symptoms, visual acuity and complications.
5 eyes of 5 patients with spontaneous FAI separation presented during the 2 year period. 4 were female, mean age was 50 years (35 - 68). Implants were placed from 2002 to 2009. Median time from insertion to separation was 135 months (range 52 -140). 4 patients presented with a new onset large floater, 1 was discovered on routine exam. 3 eyes had intraocular surgery following FAI including cataract surgery, glaucoma surgery and vitrectomy, all done within 1 year of FAI. Median time from last surgery to pellet separation was 60 months (range 48 -120). No patient had a history of ocular trauma. 4 eyes underwent removal of the pellet. In 3 cases it was for a mobile pellet in the vitreous. In 1 case the pellet appeared immobile at the vitreous base so was left in place, but was removed 7 months later when a small retinoschisis developed adjacent to the pellet. There were no surgical complications of implant removal. Visual acuity did not decrease after implant removal.
Spontaneous dissociation of FAI pellet from strut is rare. We report the largest series of spontaneous FAI strut-pellet separation. All presented to a single center in a 2 year period. There have only been 2 previous reports of spontaneous pellet separation, for a total of 6 patients, all occurring within 7 years of implantation (2,3). 3 of our patients presented 11 years after implantation, suggesting that very late dislocation may be a cause of new symptoms in this population.<br /> <br /> 1. Am J Ophthalmol 2012;154(6):969-73.<br /> 2. Ocul Immunol Inflamm. 2013;21:87-89.<br /> 3. Ocul Immunol Inflamm. 2014; 11:1-4
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