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Benjamin P. Nicholson, Rishi P. Singh, Jonathan E. Sears, Careen Y. Lowder, Peter K. Kaiser; Evaluation Of Fluocinolone Acetonide Implant (RetisertTm) Dislocation During Implant Removal/Exchange Surgery. Invest. Ophthalmol. Vis. Sci. 2011;52(14):529.
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To characterize the phenomenon of dissociation of the two components of a RetisertTM(Bausch and Lomb) implant during removal and/or exchange procedures and to evaluate patient outcomes after these events.
Retrospective review of 27 consecutive RetisertTM exchange or removal surgeries between 2001 and 2010 at Cole Eye Institute. All patients had received the implant as a treatment for non-infectious uveitis. Pre- and post-operative characteristics including visual acuity, intraocular pressure, underlying diagnoses and comorbidities, and additional medical and surgical treatments were analyzed. Operative reports were reviewed to characterize the effects of intraoperative implant dissociation.
Twenty-seven RetisertTM exchange or removal surgeries were performed by three surgeons in twenty eyes of 19 patients. Of these 27 procedures, dissociation of the implant strut from the drug-containing cup occurred in 11 eyes (40.7%). Retrieval of the dislocated cup led to intraoperative complications including posterior retinal tear (n=1) and limited suprachoroidal hemorrhage (n=1). The length of time that the implant had been in the eye correlated significantly with cup dislocation. Dissociated implants had been in the eye a mean 47.4 months, whereas intact implants had been in the eye a mean 32.5 months (P=0.0032). Implant dissociation did not correlate with surgeon experience. Eyes that had implant dissociation did not require additional surgeries, and they had similar post-operative visual acuity outcomes as eyes that did not have implant dissociation. There was no long- or short-term vision loss attributed to implant dissociation.
RetisertTM implant dissociation is a common occurrence in RetisertTM exchange procedures, and this event could in theory lead to serious adverse events. The longer an implant has been in the eye, the greater the tendency toward dissociation. Preparation for this complication should be contemplated in any implant removal/exchange procedure.
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