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C. C. Patel, N. Mandava, H. Quiroz-Mercado, S. C. Oliver, R. Braverman, J. Olson; Treatment of Intractable Posterior Uveitis in Pediatric Patients With the Fluocinolone Acetonide Intravitreal Implant (Retisert). Invest. Ophthalmol. Vis. Sci. 2010;51(13):5859.
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To evaluate the efficacy and safety of the fluocinolone acetonide intravitreal implant in pediatric patients with intractable noninfectious posterior uveitis.
A retrospective chart review was performed on all patients less than 18 years of age on whom a fluocinolone implant was used to treat intractable posterior uveitis at our institution. All patients had failed conventional treatment with topical and systemic steroids and/or systemic steroid sparing agents. Each implant contained 0.59mg of fluocinolone acetonide. Implants were placed in the inferonasal quadrant through a pars plana incision and sutured in place with 8-0 proline suture. Postoperatively, eyes were followed for improvement in Snellen visual acuity, control of inflammation and development of complications such as infection or uncontrolled intraocular pressure. Fluorescein angiography(FA) and optical coherence tomography(OCT) data was analyzed when available.
The study included 6 eyes of 4 patients(table 1). Mean age at implant placement was 9.2 years(range 6 to 13). Four eyes were pseudophakic; one eye had pars plana lensectomy at time of surgery. Mean follow-up was 278 days(range 55 to 706 days). Postoperative visual acuity improved ≥3 lines in 5 eyes. Three eyes had postoperative intraocular spikes >20mmHg; one >40mmHg. All were controlled medically. Inflammation was controlled postoperatively in all eyes without need for topical steroids. Four eyes had postoperative OCT which showed no intraretinal or subretinal fluid. One eye had a postoperative FA which showed no macular leakage. The single phakic eye had postoperative progression of cataract. There were no cases of postoperative infection. There were no postoperative complications of surgical technique including no instances of wound leakage or implant dislocation.
The fluocinolone implant can be used effectively for control of posterior inflammation in pediatric patients. As in adults, concerns for ocular hypertension and cataract development remain. No other safety concerns were evident in this pilot study.
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