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Paul S. Tlucek, James C. Folk, Jason A. Orien, Edwin M. Stone, Vinit B. Mahajan; Fluocinolone Acetonide Implantation In Autosomal Dominant Neovascular Inflammatory Vitreoretinopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5501.
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© ARVO (1962-2015); The Authors (2016-present)
To review the clinical effect of the fluocinolone acetonide implant (Retisert) in subjects with Autosomal Dominant Neovascular Inflammatory Vitreoretinopathy (ADNIV).
A retrospective case series was assembled from ADVIV patients who underwent Retisert implantation. Visual acuity and features of this inherited condition, including inflammatory cells, neovascularization, fibrosis, and cystoid macular edema were reviewed.
Seven eyes of four related ADNIV patients with uncontrolled inflammation were identified. Follow-up data of 21.7 months or greater was available in all patients (range = 21.7 - 60.7 months after primary insertion). Preoperatively, six eyes demonstrated vitreous cell, while the seventh had a diffuse vitreous hemorrhage from neovascularization. Six eyes demonstrated cystoid macular edema, five had an epiretinal membrane, and three manifested some degree of retinal neovascularization. The vision at implantation ranged from 20/50+2 to hand motion. Postoperatively, visual acuity at the most recent follow-up ranged from 20/80-1 to no light perception. Vitritis resolved in all applicable eyes. Neovascularization did not develop in the 4 eyes without evidence of new vessels at the time of initial Retisert placement. Central macular thickness, as measured by optical coherence tomography (OCT), improved in two eyes. One eye developed exuberant proliferative vitreoretinopathy early in the postoperative course and subsequent phthisis. The two phakic eyes underwent cataract surgery. Four of the five eyes without previous glaucoma surgery demonstrated elevated intraocular pressure following Retisert implantation, and three of these required glaucoma surgery.
Retisert implantation may slow the progression of specific features of ADNIV such as inflammatory cells and neovascularization, but it does not reliably stabilize long-term vision, retinal thickening, or fibrosis. All eyes in this series required cataract extraction, and most required surgical intervention for glaucoma. Further studies are needed to identify additional therapies and the possible benefit of earlier implantation.
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