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Didar Abdulla, Simon Richard Taylor; Fluocinolone acetonide intravitreal implant 0.19mg (ILUVIEN®) Vs Intravenous immunoglobulin (IvIg) in Cancer associated retinopathy.. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5179.
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© ARVO (1962-2015); The Authors (2016-present)
Cancer relapses maybe more frequent in immunosuppressed persons which makes treatment of cancer associated retinopathy (CAR) difficult. We looked to compare the results of treating CAR between an intravitreal steroid implant and intravenous immunoglobulin (IvIg).
This was a retrospective observational clinical study of 6 patients (11 eyes) over a 6 month period. The primary outcome was mean deviation (MD) of the visual field score, best corrected visual acuity (BCVA) and adverse events. We included patients with diagnosed CAR. Appropriate statistical analysis was undertaken for the small numbers.
Of the 11 eyes of 6 patients studied, 4 had IvIg and 7 had ILUVIEN®. The average BCVA of the IvIg group declined from 0.28 to 0.38 LogMAR at 6 months and improved in the ILUVIEN® group from 0.30 to 0.20 LogMAR. The MD improved in both groups, the IvIg treated patients going down from -9.39 to -3.04 and the ILUVIEN® treated eyes from -20.6 to -9.85. The IOP in the IvIg group rose from 12.25 to 14mmhg post treatment but dropped in the ILUVIEN® treated eyes from 15.28 pre-implant to 14.7mmhg at the 6 month review. No significant adverse events were recorded in either group and one eye underwent cataract surgery in the implant group after treatment. Both groups reported a subjective improvement in vision, notably improvement in colour vision. The IvIg group attended hospital 13.5 times over a 12 month period.
Cancer associated retinopathy is a rare disorder, as such there is a paucity of data in treatment approaches. Better outcomes were seen in patients treated with local rather than systemic therapy. It was challenging to collect long term data on our patients and obtain multiple visual fields due to their frail nature. Regrettably most of our patients died a short while after treatment due to their aggressive ailment. In those followed up long term, preserved visual acuity, controlled pressures, improved MD and subjective overall vision was seen in the ILUVIEN® group. We add that ILUVIEN® did not require hospital admission or multiple treatments, an important factor for cancer patients.
This is a 2020 ARVO Annual Meeting abstract.
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