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Sana Idrees, Zoe Williams, David DiLoreto, Jr; Autoimmune retinopathy treated with fluocinolone acetate intravitreal implant (Retisert). Invest. Ophthalmol. Vis. Sci. 2020;61(7):314.
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To describe the outcomes of three cases of autoimmune retinopathy (AIR) in patients treated with sustained release fluocinolone acetonide intravitreal implant.
This is a case series of three patients with autoimmune retinopathy treated with fluocinolone acetonide intravitreal implant due to inability to tolerate systemic immunosuppression. Visual acuity (VA), retinal optical coherence tomography (OCT), and visual field (VF) were followed post-operatively.
Case 1. A 64 year old male presented with cancer associated retinopathy (CAR) secondary to lung carcinoma. He had a good initial response to intravenous immunoglobulin and steroids, but was unable to tolerate steroids due to side effects or mycophenolate mofetil due to leukopenia. He underwent implantation of intravitreal fluocinolone acetonide in the right eye. His VA pre-operatively was 20/40 and one week post-operatively was 20/50 with a stable VF and OCT. His VA remained stable for 6 months until his death.Case 2. An 87 year old male presented with autoimmune retinopathy. He initially refused oncologic work-up or systemic treatment and developed progressive vision loss. Intravitreal triamcinolone injections stabilized the disease for a limited duration. He did not tolerate treatment with mycophenolate mofetil. His pre-operative VA was 20/150 in both eyes. After bilateral intravitreal fluocinolone acetonide implantation, he was 20/200 in both eyes at 15 months with relatively stable OCTs. At 2 years, he was 2/200 in the right eye and 1/200 in the left eye with worsening thinning on OCTs.Case 3. A 68 year old female presented with CAR in the setting of breast cancer. She had progressive VF loss despite intravitreal triamcinolone injections and worsened liver function with mycophenolate mofetil. She was switched to rituximab and underwent bilateral intravitreal fluocinolone acetonide implantation. At 8 months post-operatively, she maintained VA of 20/25 in both eyes and stable OCTs, but continued to demonstrate worsening peripheral VF. Intravenous immunoglobulin was started and VF stabilized 13 months post-operatively.
This case series demonstrates that adjunctive local treatment with a long acting intravitreal steroid implant should be considered in the treatment paradigm of patients with autoimmune retinopathy, especially when systemic immunosuppression is not well tolerated.
This is a 2020 ARVO Annual Meeting abstract.
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