Combined Fluocinolone Acetonide Intraocular Delivery System Insertion, Phacoemulsification, and Intraocular Lens Implantation for Severe Uveitis

Abstract

To determine whether a three-year fluocinolone acetonide sustained drug delivery system can be implanted safely at the same time that phacoemulsification and intraocular lens (IOL) implantation are performed for a visually significant cataract in eyes with uveitis. Retrospective, single-center case series. All consecutive patients treated from April 1998 through September 2006 at an academic clinical practice with intermediate uveitis, posterior uveitis, or panuveitis requiring immunosuppressive therapy, periocular corticosteroid injections, or both. Phacoemulsification, IOL implantation, and fluocinolone acetonide implant insertion were performed during a single surgical session. The main outcome measures were preoperative and postoperative ocular inflammation, visual acuity (VA), intraoperative complications, anti-inflammatory medication use, IOP, and postoperative adverse events. Twenty-four eyes of 21 patients were studied. Mean follow-up duration was 27 months (range, six to 60 months). No patients had intraoperative complications. The mean Snellen VA at baseline was 20/316, which improved significantly to 20/75 at 12 months. The average number of recurrences in the 12 months before implantation was 2.2 episodes per eye. Only one eye experienced a recurrence at seven months after implantation. Topical corticosteroids, posterior sub-Tenon capsule injections, and systemic anti-inflammatory medications were reduced significantly at 12 months. Average IOP was unchanged after surgery compared with preoperative IOP; 15% underwent glaucoma filtering surgery. A fluocinolone acetonide implant insertion can be combined safely with phacoemulsification plus IOL implantation during the same surgical session in eyes with uveitis. VA generally was improved, uveitis recurrences decreased, and the need for immunosuppression decreased. The most common side effect was increased IOP.