Abstract
Purpose :
The FDA approved corticosteroid implants for the treatment of posterior uveitis include the 0.59-mg fluocinolone acetonide implant, the 0.7-mg dexamethasone implant, and the 0.18-mg fluocinolone acetonide implant, which gained FDA clearance in October 2018. The 0.18-mg implant is marketed for up to 36 months duration. There is currently little long-term data regarding its efficacy.
Methods :
All patients with a diagnosis of posterior uveitis at a single center who received the 0.18-mg implant with at least 6-month follow-up were included. IRB approval was obtained. Characteristics analyzed included lens status, prior glaucoma surgery, prior 0.59-mg implant surgery, prior 0.7-mg implant placement, use of corticosteroid eyedrops, use of systemic immunomodulatory therapy (IMT), number of IOP lowering medications, LogMAR visual acuity, IOP, grading of anterior chamber and vitreous cell, presence of cystoid macular edema (CME), and presence of retinal vasculitis. The main outcome of interest was uveitis recurrence defined as new or worsening inflammation requiring escalation of therapy.
Results :
32 eyes were included. All patients received local corticosteroids (90.6% 0.7-mg implant, 9.3% subtenon triamcinolone) prior to implantation (mean: 2.4 months prior). Mean follow-up from baseline was 21.4 months. 18.8% of patients were phakic, 34.4% had a prior glaucoma surgery, 37.5% were on systemic IMT, 53% had CME, and 22% had retinal vasculitis. Post injection, 6, 12, and 18-month data showed 11.5%, 25%, and 25% presence of CME and 11.5%, 5%, and 0% presence of retinal vasculitis, respectively. Kaplan-Meier survival analysis (Fig. 1) demonstrated a mean time to uveitis recurrence of 17.9 months (95% CI 12.96 – 22.96). 50% (3/6) of phakic patients required cataract surgery (3, 11, and 13-months post implant). No patient required glaucoma surgery and IOP (last follow-up mean: 11.5 mmHg) did not increase during the study. No patient discontinued IMT.
Conclusions :
Initial data suggest the 0.18-mg implant may be a useful treatment. Furthermore, glaucoma status and IOP did not worsen and treatment of IOP remained minimal throughout the study. However, no patient on IMT was able to discontinue, suggesting that the implant alone may not be sufficient. This study is ongoing, and results are preliminary.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.