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M. Jancevski, C. S. Foster; The Retisert Experience. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5852.
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To review the outcomes of patients who underwent Retisert (fluocinolone acetonide) implantation for non-infectious posterior or intermediate uveitis at the Massachusetts Eye Research and Surgery Institution (MERSI).
An retrospective electronic medical records review was performed evaluating patients with a history of uveitis who received Retisert implants from 2005 to 2009 at MERSI. Data collection consisted of demographic information and clinical data from office visits. Such data included diagnosis, visual acuity, intraocular pressure, immunosuppressive therapy, corticosteroid therapy, inflammation control and complications. The primary outcome variable was need for continued immunomodulatory and/or corticosteroid therapy. Additional investigations included need for treatment of elevated intraocular pressure as well as potential complications.
After excluding eight eyes secondary to limited post-operative follow-up of less than three months, a total of 64 eyes of 51 patients were reviewed. Thirty-six (70.6%) patients were female and 15 were male. The follow-up ranged from three months to three years. Forty-three patients (89.6%) were previously treated with or currently being treated with immunomodulatory therapy for their ocular disease. At the time of surgery, 21 eyes of 17 patients were treated with immunomodulatory therapy. Nine patients successfully tolerated a decrease or discontinuance of their immunomodulatory therapy after Retisert placement. One patient required a second Retisert implant for treatment of recurrent intraocular inflammation after exhaustion of the first implant drug supply. Twenty-six eyes had a history of elevated intraocular pressure. After Retisert surgery, 30 eyes required additional topical hypotensive treatment for elevated intraocular pressure; fourteen eyes needed additional laser treatment or glaucoma filtering surgery consisting of either trabeculectomy or tube shunt placement for pressure control. Of the 14 phakic eyes, 11 eventually underwent cataract extraction during follow-up. Post-operative complications encountered included hypotony (5 eyes), vitreous hemorrhage (8 eyes), retinal detachment (4 eyes), and infection (one eye with culture-proven endophthalmitis and one eye with blebitis).
The Retisert implant is a generally well-tolerated device that enables long-term corticosteroid treatment of non-infectious inflammation. The device demonstrates a role in the decreased dependence on and even potential discontinuation of systemic immunotherapy for the treatment of uveitis. However, potential complications including elevated intraocular pressure are common.
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