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L. L. Dworkin, A. G. Prasad, C. J. Siegfried, N. M. Holekamp; Outcomes of Trabeculectomy Following Intravitreal Fluocinolone Acetonide Implant Placement. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5787.
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© ARVO (1962-2015); The Authors (2016-present)
Corticosteroid intravitreal implants provide sustained drug delivery in the treatment of various conditions, but can lead to elevated intraocular pressure requiring glaucoma filtering surgery. This review examines the long-term results of trabeculectomy in eyes with fluocinolone acetonide (FA) implants.
We performed a retrospective review of surgical outcomes in 7 eyes of 6 patients who underwent trabeculectomy surgery in the presence of a FA implant.
Seven eyes of 6 patients received FA implants for a variety of disease processes. Mean preoperative IOP on maximal medical therapy was 37 mmHg (22-66 mmHg). Mean follow-up period after trabeculectomy was 47 months (23-78 months). Mean IOP at last follow-up was 12 mmHg (4-20 mmHg). One eye required bleb needling following sequential cataract extraction, representing the only eye in which adjunctive mitomycin-C was not used at the time of trabeculectomy. One eye required a single medication for IOP control. One eye developed an early bleb leak postoperatively which resolved without complication. There were no other notable complications following the surgery. Additionally, one eye underwent repeat FA implantation with bleb preservation with short-term follow-up of 5 months.
Uncontrollable corticosteroid-induced IOP elevation secondary to intravitreal sustained-release FA implants often requires surgical intervention with trabeculectomy. Based on this small retrospective case series, trabeculectomy surgery in the presence of FA implant provides successful IOP lowering with no increase in complications. Our small case series suggests that filtration surgery in this cohort of patients is safe and effective. Further study of long-term success and delayed complications in these patients will guide future therapeutic strategies.
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