Author: João Romano (Portugal)
Co-authors: Maria J. Vieira, Joana Martins, Nuno Oliveira, Mariana Almeida, João P. Sousa
Purpose
In Europe, ILUVIEN® (0.19mg fluocinolone acetonide intravitreal implant [FAc]) is indicated for prevention of relapse in recurrent non-infectious uveitis affecting the posterior segment of the eye. The purpose of this analysis is, then, to report the outcomes of two cases of chronic non-infectious uveitis with macular edema (ME) treated with a single FAc intravitreal implant.
Setting/Venue
Ophthalmology Department of Centro Hospitalar de Leiria - Hospital Santo André, Leiria, Portugal.
Methods
Retrospective descriptive study of 2 case of chronic non-infectious uveitis with macular edema, treated with FAc, based on information from clinical records, patient observation and analysis of complimentary diagnostic tests. Outcome measures included best-corrected visual acuity (BCVA; ETDRS letters score), central macular thickness (CMT; µm), macular volume (MV; mm3) and intra-ocular pressure (IOP; mmHg).
Results
Case 1: 62-year-old woman presented with bilateral panuveitis. Examination revealed the presence of “mutton fat” keratic precipitates and absence of cells or flare in the anterior chamber. Fundoscopy revealed vitreous opacities, disc oedema and Dalen-Fuchs nodules with no activity. Systemic workup made sarcoidosis diagnosis. Patient was treated with systemic corticosteroids. After systemic steroid tapering, patient presented flare and cystoid ME. Prior FAc, the patient received 1 sub-tenon triamcinolone and 3 dexamethasone intravitreal implant (DEX) injections with good morphologic and functional response but ME recurred around 5 months post-injection. During this period, patient underwent cataract surgery and vitrectomy. Post-FAc (3.5-years), she continued with controlled ME (CMT/MV of 463µm/10.46mm3 from a baseline of 614µm/11.6mm3) and improved BCVA +15letters from baseline (60 to 75letters). Case 2: 63-year-old woman presented with flare in the anterior chamber. Fundoscopy revealed anterior vitreous organization, inferotemporal vasculitis and cystoid ME (suspicious of sarcoidosis diagnosis). Prior FAc, patient was treated with systemic corticosteroids, immunosuppressors, and 7 DEX injections – good anatomic and functional response but with recurrence. Patient underwent cataract surgery and vitrectomy. Post-FAc (1.75-years), she continued with controlled ME (CMT/MV of 386µm/8.10mm3 from a baseline of 482µm/10.17mm3) and improved BCVA +10letters from baseline (70 to 80letters).
Conlusions
The current cases reported here supports the benefit of ILUVIEN® in the treatment and prevention of relapse in recurrent non-infectious uveitis with macular edema.
Financial Disclosure
No financial conflicts of interest.
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