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Nacima Kisma, Anthony G. Robson, Graham E. Holder, Mark Westcott, Carlos Pavesio; Long Term Outcome Of Birdshot Chorioretinopathy Treated By Fluocinolone Acetonide Intravitreal Implant (Retisert®): A Case Series Report. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2737.
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To describe the clinical and electrophysiological evolution of patients with birdshot chorioretinopathy (BCR) treated with the intraocular, slow-release, steroid implant, Retisert® (0.59mg of fluocinolone acetonide) (Bausch & Lomb).
Retrospective analysis of 3 eyes of 2 patients with active BCR who were only treated with the Retisert® 0.59 mg implant and monitored with International-standard pattern and full-field ERGs (PERG; ERG).
Patient 1 (female, 67 yrs). One eye. The eye with the implant showed clinical resolution of disease with improvement of visual acuity from 6/18 to 6/6. Baseline ERGs indicated generalised cone system dysfunction with PERG evidence of macular involvement; 30Hz ERG and PERG rapidly improved and were stable 93 months after treatment. Cataract surgery was required in the implanted eye after 16 months. In the eye with no implant ERGs were initially normal but deteriorated with transient improvement to triamcinolone injections.Patient 2 (male, 43 yrs). Both eyes. Baseline electrophysiology was consistent with mild bilateral cone system dysfunction. Both eyes had implants and clinical resolution occurred. ERGs remained mildly abnormal but were stable 46 (right eye) and 39 (left eye) months after treatment. Right and left eyes needed trabeculectomy for secondary glaucoma after 9 and 4 months and cataract surgery after 24 and 18 months, respectively. In spite of stable ERGs, visual acuity decreased in both eyes. No explanation for this has been found.
This report on 2 patients suggests that the fluocinolone acetonide implant can achieve inflammatory control of BCR. Improved retinal function can persist for longer than the known duration of the drug delivery system (30 months). Cataract and glaucoma are not uncommon complications of this form of therapy.
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