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Bailey Y. Shen, Careen Y. Lowder, Jonathan E. Sears, Rishi P. Singh; Treatment Response of Fluocinolone (RetisertTM) Implantation in Those with Uveitic Macular Edema: An Optical Coherence Tomography Study. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2764.
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To analyze Spectral Domain-Optical Coherence Tomography (SD-OCT) changes after fluocinolone implantation in eyes with baseline uveitic macular edema.
Patients who had uveitic macular edema and who received fluocinolone implantations by two surgeons (RPS and JES) at the Cole Eye Institute (Cleveland Clinic, Cleveland, OH) from September 2009 to July 2010 were eligible for this study. To be included, patients had to 1) have baseline as well as three month follow-up SD-OCT scans, and 2) be on equal or lesser doses of systemic immunosuppressant therapy at follow-up scan compared to baseline scan. Patients who had an intravitreal triamcinolone injection less than four months before the follow-up SD-OCT scan were excluded. Baseline and follow-up best corrected visual acuity, intraocular pressure, central subfield thickness, cube volume, cube average thickness, and cystoid macular edema grade were recorded. Changes in these variables were analyzed using the Wilcoxon signed-rank test for paired comparisons of clustered data. P-values were two-sided, and alpha was set at 0.05.
Twelve eyes belonging to seven patients were included in the study. The median best corrected visual acuity improved after implantation (20/80 before implantation, and 20/50 after), but this improvement was not significant at three months (P = 0.12). Intraocular pressure was also not significantly different (Median pressure 15.8 mm Hg before, 15.5 after, P = 0.46). However, the SD-OCT measurements--central subfield thickness, cube volume, cube average thickness, and cystoid macular edema grade--were all significantly reduced (median change: -234 µm [P = 0.02], -1 mm3 [P = 0.04], -39 µm [P = 0.04], and -3 [P = 0.03], respectively) at three months. Nine out of the twelve eyes had a cystoid macular edema grade of zero at the three month follow-up, but two eyes had a grade of one, and one eye had a grade of two.
Fluocinolone implantation is associated with a significant reduction in macular edema at three months as measured by SD-OCT, a result which is consistent with the proposed mechanism of the drug. However, not all eyes had complete resolution of macular edema at three months as measured by SD-OCT.
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