0,19 mg Fluocinolone acetonide intravitreal implant (ILUVIEN®) effectiveness and safety outcomes on the treatment and prevention of relapse in recurrent idiopathic posterior uveitis: a bilateral case report.

Author: David Martins (Portugal)

Co-authors: Margarida Fonseca Santos

Purpose

Evaluation of the 16-month outcomes from two eyes from the same patient treated with 0.19 mg fluocinolone acetonide intravitreal implant (ILUVIEN®) for the treatment and prevention of relapse in recurrent bilateral idiopathic posterior uveitis with macular edema.

Setting/Venue

Bilateral case report from Hospital da Luz Setúbal, Portugal.

Methods

Review of a bilateral idiopathic posterior uveitis case treated with 0.19 mg fluocinolone acetonide intravitreal implant. Outcome measures included: best corrected visual acuity (BCVA; decimal scale), central retinal thickness (CRT; µm), intraocular pressure (IOP; mmHg) and vitritis presence or absence.

Results

57-year-old woman diagnosed in 2006 with a bilateral idiopathic posterior uveitis with macular edema. The patient was treated with repeated triamcinolone intravitreal injections(2006-2016), oral prednisolone 5-60 mg/day (2006-2019) and topical prednisolone 10 mg/ml (2018-2019). In 2014 the patient underwent bilateral cataract extraction. In October 2019, since the oral steroid therapy was not sustainable for this patient due to side effects and menopause, both oral and topical prednisolone were tapered and after 2 months, ILUVIEN® was injected in both eyes. Immediately before ILUVIEN administration the baseline values were recorded: BCVA of 0.3 OD/OS, CRT of 487/550µm OD/OS, IOP of 14 mmHg and vitritis in both eyes (VH 3+) - without any IOP-lowering medication-. Three days and 3 weeks post-ILUVIEN® injection, the anatomical and functional outcomes revealed significant improvement (3 days: 324 µm OD and 422 µm OS; 3 weeks: 0.5 BCVA in both eyes, 242 µm OD and 292 µm OD). 16 months post-ILUVIEN® the patient showed greater BCVA improvement (0.8 OD and 0.6+2 OS) and remained without macular edema (CRT 229 µm OD and 255 µm OD) and vitritis (VH 0). During the all follow-up period the IOP remain below 15 mmHg, without the need of IOP-lowering medication or surgery.

Conlusions

This bilateral case report reinforces the advantage of ILUVIEN® in the treatment and prevention of relapse in recurrent idiopathic posterior uveitis with macular edema. Since the 0.19 mg fluocinolone acetonide intravitreal implant is a long-acting implant that delivers 0.2µg/day of the active substance allowing the control of the inflammatory signals (i.e. in this case report, vitritis and macular edema) without systemic adverse events. Locally, ILUVIEN® was well tolerated without the need of IOP-lowering medication or IOP-lowering surgery. Considering that ILUVIEN® requires fewer injections than other alternative treatments, it gives added benefits to the patient with reduced risk of reinjection-associated adverse events, lower treatment burden, improved treatment adherence, and improved disease control.

Financial Disclosure

None