July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Dissociations of the fluocinolone acetonide implant: experience from long-term follow-up during the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study
Author Affiliations & Notes
  • Elizabeth A Sugar
    Biostatistics, Johns Hopkins University, Baltimore, Maryland, United States
    Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States
  • Janet A Holbrook
    Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States
  • Alyce E Burke
    Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States
  • Glenn J Jaffe
    Duke Eye Center, Duke University, Durham, North Carolina, United States
  • Albert T Vitale
    Ophthalmology, Moran Eye Institute/University of Utah, Salt Lake City, Utah, United States
    Medicine, Mount Sinai School of Medicine, New York, New York, United States
  • Janet L. Davis
    Bascom Palmer Eye Institute/Ophthalmology, University of Miami , Miami, Florida, United States
  • Douglas A Jabs
    Ophthalmology, Mount Sinai School of Medicine, New York, New York, United States
    Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Elizabeth Sugar, None; Janet Holbrook, None; Alyce Burke, None; Glenn Jaffe, AbbVie (C), Alcon (C); Albert Vitale, AbbVie (C), ACIONT (C); Janet Davis, AbbVie (C), Allergan (C); Douglas Jabs, None
  • Footnotes
    Support  NEI Grants U10EY014660, U10EY014655, U10EY014656
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 417. doi:
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    • Get Citation

      Elizabeth A Sugar, Janet A Holbrook, Alyce E Burke, Glenn J Jaffe, Albert T Vitale, Janet L. Davis, Douglas A Jabs; Dissociations of the fluocinolone acetonide implant: experience from long-term follow-up during the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study. Invest. Ophthalmol. Vis. Sci. 2018;59(9):417.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To quantify the long-term risk of spontaneous and surgical dissociations for the 250 eyes receiving a fluocinolone acetonide implant during the Multicenter Uveitis Steroid Treatment Trial and Follow-up Study.

Methods : Dissociation was defined as the separation of the drug pellet from the strut and classified as spontaneous or surgical if identified during clinical observation or surgery, respectively. Demographic and clinical data immediately prior to implant were collected along with surgical details. Visual acuity was measured using logarithmic (ETDRS) visual acuity charts.

Results : Sixty-three dissociations were reported with 61 (42 spontaneous and 19 surgical) initial implantation. The 9-year cumulative proportion with spontaneous dissociation was 33.7% (95% confidence interval [CI]: 22.7%-43.1%, Figure 1). Eyes with a vitrectomy during implant placement were at higher risk for spontaneous dissociation (Harzard ratio: 3.1, p = 0.033). Nineteen eyes (23.2%, 95% CI: 13.8%-32.5%) had a surgical dissociation. Time since implantation (per year Adjusted Odds Ratio [aOR]: 1.66, p = 0.003) was associated with increased risk of surgical dissociation. Just over a quarter of eyes reported meaningful vision loss (≥ 15 letters) among both the spontaneous and surgical dissociations.

Conclusions : The risk of spontaneous and surgical dissociation increases substantially the longer the implant remains in the eye. Given the potential for substantial vision loss that may not be recoverable, if replacement is needed then the data suggest that the original implant be removed as the new implant is placed.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Figure 1. Kaplan-Meier estimate of time to spontaneous dissociations in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study. The black line represents the estimate with the 95% confidence interval boundaries in grey.

Figure 1. Kaplan-Meier estimate of time to spontaneous dissociations in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study. The black line represents the estimate with the 95% confidence interval boundaries in grey.

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