COMMENTARY

Treating Posterior Uveitis

Rod Foroozan, MD

Disclosures

October 02, 2008

Introduction

The treatment of posterior uveitis has traditionally involved corticosteroids, typically orally or intravenously.[1] Other immunomodulators may become necessary in patients with inflammation that cannot be adequately controlled or in patients who need prolonged therapy or become intolerant of corticosteroids. Unfortunately, topical or local therapy may not be sufficient to control posterior segment inflammation in many patients. A more recent directed therapy involves the implantation of a sustained-release form of corticosteroid within the vitreous cavity. The fluocinolone acetonide (FA) intravenous implant was designed to release corticosteroids over a 30-month period. The authors of this 3-year, multicenter, randomized, controlled trial studied the effects of the FA (either 0.59 mg or 2.1 mg) implant in patients with noninfectious posterior uveitis.

Treatment of Posterior Uveitis with a Fluocinolone Acetonide Implant: Three-Year Clinical Trial Results

Callanan DG, Jaffe GJ, Martin DF, Pearson PA, Comstock TL
Arch Ophthalmol. 2008;126:1191-1201

Summary

The study randomized 278 patients to receive either the 0.59-mg FA implant (N = 110) or the 2.1-mg FA implant (N = 168) after a scleral opening was created at the pars plana. The recurrence rate of uveitis was reduced from 62% to 4%, 10%, and 20% during the 1-, 2-, and 3-year postimplantation periods, respectively, for the 0.59-mg dose. Reductions with 2.1-mg dose were similar. Eyes implanted with FA had a higher incidence of intraocular pressure elevation compared with eyes that were not implanted. Filtering surgery was required in 40% of FA implanted eyes compared with 2% of nonimplanted eyes. Cataract surgery was performed in 93% of phakic implanted eyes compared with 20% of phakic nonimplanted eyes. Visual acuity remained stable or improved over baseline in most eyes during the 3-year study period.

Comment

Implantation of FA reduced the recurrence rate of uveitis; however, most patients required cataract extraction and many required glaucoma-filtering surgery. There was also an 80% reduction in the need for systemic medications to control inflammation, and this rate of reduction was greater than the rate of intravitreal injection of corticosteroids. An accompanying editorial noted the importance of this study toward gaining an understanding of the effects of local corticosteroid therapy.[2] The authors also noted the extensive risk for side effects, including the need for cataract surgery, glaucoma-filtering surgery, early and late-onset hypotony, and endophthalmitis and retinal detachment, and concluded that the benefits and risks for treatment must be fully discussed with the patient before embarking on therapy.

Abstract

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