Author: Mário Lima Fontes (Portugal)
Co-authors: Mariana Leuzinger Dias, Cláudia Oliveira Ferreira, Fernando Falcão Reis, Joana Araújo, Marta Inês Silva, Luís Figueira
Purpose
Inflammatory macular edema (ME) is one of the main reasons for vision loss in patients with non-infectious uveitis (NIU). There are several different local and systemic treatments available to treat uveitis, which help to reduce inflammation and to resolve macular edema. Considering the wide spectrum of uveitis’ etiologies, an individualized treatment approach is required. Corticosteroid implants have gained growing interest in this pathology due to their sustained effect in stabilizing disease activity. ILUVIEN® (fluocinolone acetonide, FAc 0.19 mg intravitreal implant in applicator) is a corticosteroid indicated for prevention of relapse in recurrent non-infectious uveitis affecting the posterior segment of the eye (NIU-PS). The aim of this case report series was to evaluate effectiveness and safety of fluocinolone acetonide implant in the treatment of non-infectious uveitic macular edema.
Setting/Venue
Retrospective observational case report series, that assesses the effectiveness and safety after FAc implant in patients with recurrent ME related no NIU, at Centro Hospitalar Universitário São João, Porto, Portugal.
Methods
Retrospective case series that encompasses 6 eyes from 5 patients with recurrent non-infectious uveitic macular edema treated with a single fluocinolone acetonide implant. Mean follow up after FAc implant was 19.8 ± 11.3 months. Demographics, form of uveitis, previous treatments, best-corrected visual acuity (BCVA, ETDRS letters), central macular thickness (CMT, μm), intraocular pressure (IOP, mmHg) and IOP lowering medication needed before FAc implant were recorded at baseline. Highest BCVA and IOP values and lowest CMT values registered throughout the study were recorded as well as time to edema recurrence and the need of hypotensive drops. Significant macular edema reduction was defined as CMT < 300μm or a decrease in CMT > 20%.
Results
Six eyes from 5 patients with mean age of 55.2 ± 9.9 years were included. Four patients were female, and all were pseudophakic at baseline. Four of the eyes had been diagnosed with anterior uveitis, 1 eye with posterior uveitis and 1 eye with panuveitis. All cases of uveitis were idiopathic/undifferentiated. Prior to FAc implant, all eyes were under systemic therapy with oral corticosteroids and/or immunosuppressive agents, and performed intravitreal short-action corticosteroids that conduced to macular edema reduction but with quick relapse after 1 to 6 months. At baseline, BCVA was 45.0 ± 23.2 ETDRS letters, CMT was 474.7 ± 127.0 μm and IOP was 14.0 ± 4.8 mmHg. After FAc implant, all eyes achieved criteria for macular edema reduction with a peak functional gain of 16.7 ETDRS letters and a maximum anatomical reduction of 205.7 μm. Throughout this study, 80% showed no recurrence of edema and 1 eye saw its edema relapsing after 28 months. Maximum value of IOP registered was 15.2 ± 4.4 mmHg, at a mean follow-up period of 10.7 ± 7.0 months. No IOP lowering drugs were needed for any eye during follow-up.
Conlusions
In this case series report, the treatment of non-infectious uveitic macular edema with FAc implant was associated with visual acuity gains and significant reductions of CMT, as well as improved control of inflammatory activity and prevention of edema recurrence. No additional safety concerns were observed after FAc implant. These results were consistent to those described in the pivotal study PSV-FAI-001.
Financial Disclosure
None.
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