Fluocinolone acetonide 0.18-mg implant for treatment of recurrent inflammation due to non-infectious uveitis: a case series of 15 patients

IF 2.9 Q1 OPHTHALMOLOGY
Robert A. Sisk, Daniel F. Kiernan, David Almeida, Anton M. Kolomeyer, David Eichenbaum, John W. Kitchens
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引用次数: 0

Abstract

Uncontrolled non-infectious uveitis affecting the posterior segment (NIU-PS) can lead to vision loss due to repeated bouts of inflammation and consequent tissue damage. Patients with chronic NIU-PS who experience recurrent uveitis after being treated with systemic and short-acting local corticosteroids may benefit from the sustained-release 0.18-mg fluocinolone acetonide implant (FAi). In this case series, 18 eyes with chronic, recurrent NIU-PS and cystoid macular edema (CME) treated with the 0.18-mg FAi were analyzed retrospectively. Data on patient demographics, clinical history, previous and concomitant treatments for uveitis recurrence, time to and number of uveitis recurrences, intraocular pressure (IOP), central subfield thickness (CST), and visual acuity (VA) were collected and summarized. A majority of patients (14/15 [93%]) had a history of ocular surgery, largely cataract extraction, and all developed chronic and recurrent NIU-PS and CME. At baseline, patients had a mean age of 72 years (range: 46 to 93), were 53% male, and had a mean duration of NIU-PS of 3 years (range: 1 to 19). Patients were followed for an average of 16.5 months (range: 2 to 42.5 months) post FAi. Eleven of the 18 eyes (61%) had ≥ 5 recurrences of uveitis since diagnosis, with an average time to recurrence of approximately 12 weeks (range: 1 to 27). All eyes treated with the 0.18-mg FAi showed reduced NIU-PS recurrence and visual and anatomical improvement, as measured by VA and CST, respectively. Two eyes had an IOP elevation that was managed with topical therapy, and one eye was treated with topical prednisolone for additional inflammation management. Two eyes required adjunct therapy with short-acting intravitreal corticosteroids at 7 and 16 weeks for NIU-PS recurrence after 0.18-mg FAi insertion. After receiving the 0.18-mg FAi, eyes with uncontrolled NIU-PS had sustained resolution of CME and inflammation with limited need for supplementary steroid drops or injections and minimal steroid class-specific adverse effects; none required incisional IOP-lowering surgery.
治疗非感染性葡萄膜炎复发性炎症的 0.18 毫克氟西诺龙醋内酯植入剂:15 例患者的病例系列研究
影响后节的非感染性葡萄膜炎(NIU-PS)如果得不到控制,就会因反复发作的炎症和随之而来的组织损伤而导致视力下降。慢性 NIU-PS 患者在接受全身性和短效局部皮质类固醇治疗后,如果出现葡萄膜炎复发,可能会从 0.18 毫克氟西诺龙醋酸酯缓释植入剂(FAi)中获益。在这一病例系列中,我们对使用 0.18 毫克 FAi 治疗慢性、复发性 NIU-PS 和囊样黄斑水肿(CME)的 18 只眼睛进行了回顾性分析。研究人员收集并总结了患者的人口统计学资料、临床病史、葡萄膜炎复发的既往治疗和伴随治疗、葡萄膜炎复发的时间和次数、眼压(IOP)、中央子场厚度(CST)和视力(VA)等数据。大多数患者(14/15 [93%])都有眼科手术史,主要是白内障摘除术,并且都患上了慢性和复发性 NIU-PS 和 CME。基线时,患者的平均年龄为 72 岁(46 至 93 岁),53% 为男性,NIU-PS 的平均持续时间为 3 年(1 至 19 年)。患者在 FAi 术后平均接受了 16.5 个月(2 至 42.5 个月)的随访。18只眼睛中有11只(61%)自确诊以来葡萄膜炎复发≥5次,平均复发时间约为12周(范围:1至27周)。所有接受0.18毫克FAi治疗的眼睛都显示NIU-PS复发率降低,视力和解剖结构得到改善,分别以VA和CST来衡量。有两只眼的眼压升高通过局部治疗得到了控制,有一只眼通过局部泼尼松龙进行了额外的炎症控制。两只眼睛在植入 0.18 毫克 FAi 后,由于 NIU-PS 复发,分别需要在 7 周和 16 周使用短效玻璃体内皮质类固醇辅助治疗。在接受 0.18 毫克 FAi 治疗后,NIU-PS 未得到控制的眼睛的 CME 和炎症得到了持续缓解,对补充类固醇滴眼液或注射的需求有限,类固醇类药物的不良反应也很小;没有一双眼睛需要进行切口降眼压手术。
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来源期刊
CiteScore
3.80
自引率
3.40%
发文量
39
审稿时长
13 weeks
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