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Afsheen A. Khwaja, J Wang, E Hatef, J Heo, J H. Lee, Y J. Sepah, R Channa, T Albini, S Srivastava, Q D. Nguyen; Predictors of Recurrent Inflammation in Patients with Noninfectious Posterior Uveitis Managed with Intravitreal Fluocinolone Acetonide Implants. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6567.
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To determine the predictors of recurrence (RC) in patients with noninfectious posterior uveitis (NIPU).
Analyses included 278 patients in a 3-year (yr) randomized masked multicenter trial of intravitreal Fluocinolone Acetonide (FA) implant (Retisert®) containing 0.59 or 2.1 mg of FA. Patients were 6 yrs of age or older, had unilateral or bilateral recurrent NIPU for ≥1 yr, with ≥2 recurrent episodes of NIPU requiring corticosteroid (CS) treatment in 6 months prior to enrollment (PE). Multiple logistic regression was used to evaluate predictors of RC between two groups, adjusting for age, gender, various treatments PE, presence of cystoid macular edema, and disease severity.
Mean age of all patients was 44 yrs (+15.5); 72% were female. 110 and 168 patients were treated with the low and high dose of FA implant respectively. No significant difference in age, gender, or race distribution between two dose groups was found. 113 patients from two dose groups had ≥1 RC after FA implant. Mean age of patients: with RC = 41 (+15.6yrs), no RC = 46 (+15.2yrs); p=0.01. After adjustment for other factors in regression model, there was 3% decrease in RC with 1-yr increase in age (P= 0.02). RC was 3.27 (95% CI: 1.10, 9.72) times more common among those with topical/ regional CS (TRCS) treatment compared to those not treated with TRCS. There was 28% increase in RC among those who received immunomodulatory treatment (IMT) compared to no IMT group (P=0.43). Among patients with available data on disease severity, those with more disease activity (manifested by vitreous haze), were more likely to have RC (P=0.002).
The index study provides additional information about our understanding of factors playing a role in RC among patients with NIPU receiving FA implant. Patients treated with TRCS may have had more recurrent diseases requiring supplemental regional treatments before FA, hence more RCs after FA placement. Patients on IMT before FA had more RC, implying that those with more aggressive disease and needing IMT or those who received FA following IMT treatment, were more likely to have RC. Hence, the results may suggest that subjects with NIPU who are treated earlier in the course of their diseases with FA may be less likely to have RC.
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