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Tara Golisch, Bret A. Hughes, Tamer H. Mahmoud, Chaesik Kim; Intraocular Pressure in Uveitic Eyes after Combined Fluocinolone Acetonide Intravitreal Implant (Retisert) and Ahmed Valve Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3722.
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Many patients who receive fluocinolone acetonide (Retisert) implant for chronic, non-infectious posterior uveitis already have uncontrolled uveitic glaucoma, and additionally develop steroid-induced glaucoma. Placement of the fluocinolone acetonide implant (Retisert) and a glaucoma drainage device is often staged, but there may be added benefit to combining procedures for patients on maximum tolerated medical therapy. Minimizing postoperative inflammation, controlling and preventing future spikes in IOP, as well as reducing the anesthetic risks and costs of multiple surgeries are just a few of the possible advantages. In this study, we examined intraocular pressure in eyes that underwent combined fluocinolone acetonide (Retisert) implant placement and Ahmed valve surgery.
This was a retrospective review of 13 eyes of 9 patients that underwent combined fluocinolone acetonide (Retisert) implant placement and Ahmed valve surgery for management of uveitic glaucoma. All patients were seen at Kresge Eye Institute between October 1, 2008 and June 1, 2011. Surgeries were performed in the same surgical session by a single vitreoretinal surgeon (T.H.M.), who inserted the fluocinolone acetonide (Retisert) implant, and by a single glaucoma surgeon (B.A.H.), who placed the Ahmed valve drainage device. All eyes were followed for a minimum of 3 months (mean 13.6 months). All eyes had baseline and subsequent measurement of intraocular pressure and visual acuity. Number of IOP-lowering and anti-inflammatory medications were also noted.
Prior to surgery, maximum mean IOP +/- SE was 32.8 +/- 12.2 mm Hg (n=13, range 14-50 mm Hg), and mean preoperative IOP +/- SD was 17.5 +/- 7.1 (n=13, range 9-32 mm Hg). The mean IOP at 3, 6, 9, 12, and 18 months after surgery were 14.3 +/- 2.4 mm Hg (n=12), 14.5 +/- 3.5 mm Hg (n=12), 14.33 +/- 1.3 mm Hg (n=10), 14.7 +/- 3.3 mm Hg (n=10), 11.9 +/- 3.1 mm Hg (n=7). The mean number of IOP-lowering drops before surgery was 2.6 +/- 1.3. Only one of 10 eyes required IOP-lowering medication (2 drops) at 12 months, and none of the 7 eyes followed to 18 months required any IOP-lowering drops. All 4 patients taking oral acetazolamide before surgery were able to discontinue it immediately after surgery. No patients required additional glaucoma surgery to reduce pressure at maximum follow up.
Eyes with chronic, non-infectious posterior uveitis and glaucoma require management of both of these diseases. This study suggests that combined fluocinolone acetonide (Retisert) implant placement and Ahmed valve surgery may safely and better reduce and maintain IOP in patients with uveitic glaucoma.
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