Results of Cataract Extraction and Filtration Surgery Following Fluocinolone Acetonide Sustained Drug Delivery Implant for Posterior Uveitis

Abstract

Purpose:: A fluocinolone acetonide sustained drug delivery implant (FA) effectively controls inflammation and decreases the need for adjunctive therapy in eyes with non-infectious posterior uveitis. Cataract and elevated IOP are the primary adverse events, and may require phacoemulsification and IOL implantation, and/or filtration surgery. The outcomes in eyes that have undergone these procedures, among those with an FA implant are unknown. In this report we determined the safety and efficacy of cataract extraction and filtration surgery in eyes that had a 3-year treatment history with the FA implant.

Methods:: A total of 278 posterior uveitis patients were treated with 0.59 mg or 2.1 mg FAs in their more severely diseased eye and followed-up for 3 years. Primary outcomes measured included the change in visual acuity, and adverse events among eyes that underwent cataract extraction and/or filtering surgery.

Results:: Twenty percent of eyes that received implants had 3 or more line VA improvement at 3 years, compared to 5% of non-implanted eyes. By three years nearly all phakic implanted eyes had undergone cataract extraction (93%) compared to 20% of fellow eyes. Following cataract extraction, implanted eyes showed greater improvement in VA (p≤0.005) and less AC inflammation (p≤0.01) at 1 and 3 months than non-implanted eyes. 40% of all study eyes had filtering procedures, compared to 2% of fellow eyes. Investigators reported that 73% of the filtered implanted eyes versus 57% of the fellow eyes fully recovered while 26% of the filtered implanted eyes and 43% of the fellow eyes recovered with sequelae. Final IOP in eyes with at least 6M post-filter follow-up was 14.3 mm Hg and 9 out of 10 eyes had a last measured IOP below 20 mm Hg. The rate of VA increase at 3 years in the subset of patients that required a filtering procedure was 20%, the same that was seen for the total population.

Conclusions:: At 3 years, cataract and increased IOP requiring surgical management were often observed in eyes that underwent FA placement for posterior uveitis. However these surgical procedures generally produced successful outcomes, that were comparable to, or better than those obtained in fellow, non-FA-implanted eyes.

Keywords: uveitis-clinical/animal model • corticosteroids • clinical (human) or epidemiologic studies: outcomes/complications