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M. J. Mequio, T. H. Mahmoud, O. F. Abbasi, J. E. Puklin; Immunosuppresion After Fluocinolone Acetonide Implant at a Tertiary Care Center. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5871.
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To review the use of topical and systemic immunosuppression after fluocinolone acetonide implantation for non-infectious uveitis.
Retrospective chart review of patients that had fluocinolone acetonide implants at Kresge Eye Institute since its FDA approval in 2005. Use of topical, systemic immunosupression, and number of uveitis flares were analyzed postoperatively at 3, 6, 9, 12, and 24 months. Exclusion criteria included follow up of less than 3 months and insufficient data about immunosuppression use.
Data from 35 eyes of 25 patients was available for analysis. The mean age was 49.2 ± 8.5 years. Sixteen patients were female and 8 were males. Eighteen patients were African-American and 6 were Caucasian. Seventeen eyes had idiopathic non-infectious uveitis, 9 had uveitis and a history of sarcoidosis, 4 eyes had uveitis associated with Vogt-Koyanagi-Harada Syndrome, 2 had serpiginous choroiditis, 1 eye had uveitis associated with Rheumatoid Arthritis and 1 had uveitis associated with HLA B27. Prior to implantation 27 of 35 (77%) of eyes were on topical steroids and 25 of 35 (69%) of eyes were on systemic immunosuppression. Systemic therapy included 13 on oral prednisone alone and 9 on prednisone plus methotrexate, 2 on prednisone plus mycofenolate and 1 on prednisone plus azathioprine. Average follow up was 11.9 ±6.9 months. Postoperatively 32 of 35 eyes were on topical steroids at 3 months, 7 of 32 eyes at 6 months, 7 of 19 eyes at 9 months, 3 out of 16 eyes at 1 year and one of the 9 patients at 2 years. Systemic immunosuppression was necessary in 22 of the 25 eyes at 1 month, 18 of 23 at 3 months, 7 of 22 eyes at 6 months, 5 of 14 at 9 months, 1 of 13 at 1 year. None of 7 eyes that had follow up at 2 years needed systemic immunosuppresion. Fives eyes had uveitis flares during follow up. One patient was controlled with a single injection of subtenons kenalog, one was controlled with topical steroid, one was restarted on oral prednisone with successful taper and the final patient was started on mycofenolate with successful withdrawal.
The fluocinolone acetonide implant appears to effectively control intraocular inflammation and decrease the use of both systemic and topical immunosuppression. This correlates with the initial pilot study used to investigate the fluocinolone acetonide implant.
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