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J. J. Chieh, G. J. Jaffe; Combined Fluocinolone Acetonide Sustained Drug Delivery System Implantation and Phacoemulsification/Intraocular Lens Implantation in Patients With Severe Uveitis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5131.
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To determine whether a 3-year fluocinolone acetonide sustained drug delivery system (FA) safely suppressed postoperative inflammation when combined with phacoemulsification and posterior chamber intraocular lens implantation (phaco/PCIOL) in patients with severe noninfectious posterior uveitis.
Retrospective, single center case series.
Twenty-three eyes of 21 patients with posterior or pan-uveitis requiring immunosuppressive therapy and/or periocular corticosteroid injections underwent simultaneous FA implantation (0.59 mg or 2.1 mg) and phaco/PCIOL. Patients were observed at 1 month and approximately every 3 months through 12 months after implantation.
Mean follow-up duration was 26 months (range 3 - 60) and 70% had 12 months follow-up. None of the patients had intraoperative complications. 65% of eyes had synechiolysis during phaco/PCIOL. The mean baseline VA for the device-implanted eyes was +1.21 logMAR units (20/350), which improved significantly to +0.62 logMAR units (20/80) at 12 months. Nine of the 16 eyes improved 4 or more lines. Eight of 16 eyes had a final VA of 20/40 or better. The average number of recurrences in the 12 months before implantation was 2.3 episodes per eye. Only one eye experienced a recurrence at 7 months after implantation. There was a statistically significant progressive reduction of topical corticosteroid use in the device-implanted eyes at 3, 6, 9, and 12 months (P < 0.02). The total number of posterior sub-Tenon’s capsule injections (PST) decreased from thirty-seven 12 months preop to one injection 12 months postop. Of 17 patients, 82% had a reduced dosage of systemic anti-inflammatory medication at their last follow-up visit. The mean preop IOP was 14.8 (range: 6 - 41). At 12 months, the mean postop IOP was 14.5 (n=16; range 0 - 40), 48% of implanted eyes required ocular antihypertensive drops, and 13% underwent glaucoma filtering surgery.
Main Outcome Measures::
Preoperative (preop) and postoperative (postop) ocular inflammation, visual acuity (VA), intraocular pressure (IOP), operative complications, anti-inflammatory medication use, and postop adverse events.
FA implantation and phaco/PCIOL can be combined safely in patients with posterior or panuveitis. FA implantation effectively reduces uveitis recurrences, improves VA and decreases the need for immunosuppression in this complicated group of patients. The most common side effect was increased intraocular pressure. The FA implant is a promising therapy for patients with severe uveitis and cataract.
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