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Evaluating Two Challenging Cases

Retinal Physician March 1, 2011

Evaluating Two Challenging Cases

In the following cases, Retisert® (fluocinolone acetonide intravitreal implant 0.59 mg) brought chronic posterior uveitis under control and returned vision to what may be the best level anatomically possible due to cumulative damage from chronic recurrent inflammation. Since implantation, neither patient has required additional medication to control intraocular inflammation.

Under the care of another physician, Patient One had been taking oral corticosteroids for quite some time, not tolerating them well, and her visual acuity had continued to deteriorate. VA was counting fingers in the right eye and 20/50 in the left eye. Fluorescein angiography showed bilateral subtle leakage due to multifocal choroiditis with panuveitis.

The patient underwent Retisert implantation in both eyes, which reduced the amount of leakage visible on angiography (Figures 1-4). Subsequently, she had cataract surgery with IOL implantation and IOP-lowering surgery in both eyes, to which she responded well.

Figures 1-4. Right and left eyes of a patient implanted with Retisert to control multifocal choroiditis with panuveitis. Note the reduced leakage on fluorescein angiography.

At the most recent follow-up visit, VA was 20/50 in the right eye and 20/20 in the left eye. Damage likely caused by inadequate control of inflammation by oral steroids may not allow further vision improvement in the right eye.

Patient Two had been taking oral corticosteroids to combat punctate inner choroidopathy, which can be an aggressively recurring condition. Vision in the right eye continued to deteriorate and was 20/200 upon presentation. Fluorescein angiography revealed light leakage, but color fundus photography showed soft-edged, obviously active, lesions.

Retisert implantation quieted the lesions, and VA improved to 20/25 (Figures 5-8).

Figures 5-8. Right eye of a patient with punctate inner choroidopathy before and after Retisert implantation. Leakage from formerly active lesions was reduced as evidenced by the now distinct borders.

REFERENCES
1. Brumm MV, Nguyen QD. Fluocinolone acetonide intravitreal sustained release device — a new addition to the armamentarium of uveitic management. Int J Nanomedicine 2007;2(1):55-64.
2. Ocular Immunology and Uveitis Foundation. Patient Information: What is a uveitis specialist? http://www.uveitis.org/kids/OI.htm. Accessed Sept. 1, 2010.
3. Nguyen QD, Callanan D, Dugel P, Godfrey DG, Goldstein DA, Wilensky JT. Treating chronic noninfectious posterior segment uveitis: the impact of cumulative damage. Proceedings of an expert panel roundtable discussion. Retina 2006 Oct;Suppl:1-16.
4. Jaffe GJ, Martin D, Callanan D, Pearson PA, Levy B, Comstock T; Fluocinolone Acetonide Uveitis Study Group. Fluocinolone acetonide implant (Retisert) for noninfectious posterior uveitis: thirty-four-week results of a multicenter randomized clinical study. Ophthalmology 2006;113(6):1020-1027.
5. Retisert full prescribing information. http://www.bausch.com/en_US/downloads/ecp/pharma/general/retisert_pkginsert. pdf. Accessed Sept. 10, 2010.
6. Lardenoye CW, van Kooij B, Rothova A. Impact of macular edema on visual acuity in uveitis. Ophthalmology 2006;113(8):1446-1449.
7. Callanan DG, Jaffe GJ, Martin DF, Pearson PA, Comstock TL. Treatment of posterior uveitis with a fluocinolone acetonide implant: three-year clinical trial results. Arch Ophthalmol 2008;126(9):1191-1201.
8. Goldstein DA, Godfrey DG, Hall A, et al. Intraocular pressure in patients with uveitis treated with fluocinolone acetonide implants. Arch Ophthalmol 2007;125(11):1478-1485.
9. Nguyen QD, Callanan DG, Goldstein DA, et al. Clinical perspectives and considerations with Retisert® (fluocinolone acetonide intravitreal implant) 0.59 mg in the management of chronic non-infectious uveitis of the posterior segment: expertise beyond the 3-year follow-up clinical trial data. Retina 2009;Nov-Dec Suppl:1-20.
10. Galor A, Margolis R, Kaiser PK, Lowder CY. Vitreous band formation and the sustained-release, intravitreal fluocinolone (Retisert) implant. Arch Ophthalmol 2007;125(6):836-838.
11. Seth RK, Gaudio PA. Treatment of serpiginous choroiditis with intravitreous fluocinolone acetonide implant. Ocul Immunol Inflamm 2008;16(3):103-105.
12. Mahajan VB, Gehrs KM, Goldstein DA, Fischer DH, Lopez JS, Folk JC. Management of sympathetic ophthalmia with the fluocinolone acetonide implant. Ophthalmology 2009;116(3):552-557.
13. Pavesio C, Zierhut M, Bairi K, Comstock TL, Usner DW; Fluocinolone Acetonide Study Group. Evaluation of an intravitreal fluocinolone acetonide implant versus standard systemic therapy in noninfectious posterior uveitis. Ophthalmology 2010;117(3):567-575.
14. Jaffe GJ. Reimplantation of a fluocinolone acetonide sustained drug delivery implant for chronic uveitis. Am J Ophthalmol 2008;145(4):667-675.
15. Taban M, Lowder CY, Kaiser PK. Outcome of fluocinolone acetonide implant (Retisert) reimplantation for chronic noninfectious posterior uveitis. Retina 2008;28(9):1280-1288.
16. Yeh S, Cebulla CM, Witherspoon SR, et al. Management of fluocinolone implant dissociation during implant exchange. Arch Ophthalmol 2009;127(9):1218-1221.

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