Imaging-Based Rescue of Uveitis Patients Treated With Injectable Fluocinolone Acetonide

Abstract

Purpose : Injectable Fluocinolone Acetonide (FA) was approved in 2018 for treatment of non-infectious uveitis (NIU) affecting the posterior segment. We monitored the incidence of rescue events in a year long prospective investigator initiated study (IIS) evaluating imaging outcomes in patients treated with the FA implant.

Methods : A total of 31 adult NIU patients on FA 0.18mg were initially enrolled in an IIS. 27 NIU patients (13 males; 14 females) (17 white; 10 black) (n=32 eyes) were included in this analysis with a baseline visit and at least one month follow-up. Imaging including OCT and wide field fluorescein angiography were performed at study visits. Criteria for treatment rescue involved the use of additional intravitreal (IV) injections or an increase in immunosuppression to treat resilient and/or worsening leakage on imaging. Patients with bilateral eye disease who received systemic rescue treatment for only one worsening eye had their other eye excluded from primary calculations. 32 different sets of eyes were included for the 1 month, 3 month, and 6 month follow-up data, respectively. 26 eyes were included for 9 month follow-up. 19 eyes were included for 12 month follow-up.

Results : 10 of 32 eyes (9/27 pts) required rescue within one year (31%). Five patients required at least two rescues. On average, 11% of eyes required rescue within 6 months and 16% after 6 months. Three patients with bilateral eye disease received systemic rescue treatment for only one worsening eye (one patient at the 6 month, 9 month, and 12-month follow-up, respectively); the other eye for these patients were excluded. Treatments included NSAID eye drops, steroid eye drops, systemic steroids, dexamethasone intravitreal implants, triamcinolone acetonide injections, repeat FA 0.18mg implants, and FA 0.59mg implants.

Conclusions : About one-third of patients on FA 0.18mg will require rescue treatment within one year. The most likely time for rescue will be around six months to one year following initiation of treatment.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.