Abstract
To evaluate outcomes in birdshot chorioretinopathy following intravitreal implantation of a fluocinolone acetonide-containing drug delivery device. Retrospective, multicenter, interventional case study. University- and community-based tertiary care. Twenty-two HLA-A29+ birdshot patients (36 eyes) were implanted with a sustained-release corticosteroid device and followed for up to 3 years. Main outcome measures were Snellen acuity, intraocular inflammation, adjunctive therapy, cataract, ocular hypertension, or glaucoma. Paired Wilcoxon statistics were used to analyze visual acuities; paired McNemar statistics were used to analyze presence or absence of other outcomes. Nineteen of 22 patients (32 eyes) completed 12 months of follow-up with improvement in median visual acuity (P=.015). Prior to implantation, 18 of 22 patients (82%) received immunosuppressive therapy versus 1 of 19 (5%) by 12 months (P<.001). Eyes with zero vitreous haze increased from 7 of 27 scored eyes (26%) at baseline to 30 of 30 eyes (100%) by 12 months (P<.001). Cystoid macular edema decreased from 13 of 36 eyes (36%) at baseline to 2 of 32 eyes (6%) at 12 months (P=.006). Five of 24 phakic eyes at baseline exited the study before surgery; all other eyes received cataract surgery. One hundred percent of study eyes had ocular hypertension, required intraocular pressure-lowering therapy, or had glaucoma surgery by 12 months. Implantation of a fluocinolone acetonide-containing intraocular device in birdshot chorioretinopathy can improve vision, control inflammation, and eliminate systemic therapy. There is a high incidence of cataract progression and intraocular hypertension or glaucoma.
Highlights
The late stage is typified by cystoid macular edema (CME), vascular attenuation, and retinal pigment epithelial (RPE), choroidal and optic nerve atrophy
We report our experience with implantation of an FDA-approved, sustained-release intraocular implantable drug delivery device containing fluocinolone acetonide in one or both eyes of 22 patients with birdshot chorioretinopathy. 21
Surgical logs were reviewed to identify patients with birdshot chorioretinopathy who were implanted with fluocinolone acetonide containing drug delivery devices (Retisert®, Bausch & Lomb, Rochester, New York) from 2002 to 2008 at Bascom Palmer Eye Institute, the
Summary
University and community-based tertiary care. 22 HLA-A29+ birdshot patients (36 eyes) were implanted with a sustained-release corticosteroid device and followed for up to 3 years. 22 HLA-A29+ birdshot patients (36 eyes) were implanted with a sustained-release corticosteroid device and followed for up to 3 years. Main outcome measures were Snellen acuity, intraocular inflammation, adjunctive therapy, cataract, ocular hypertension or glaucoma. Paired Wilcoxon statistics were used to analyze visual acuities; paired McNemar statistics were used to analyze presence or absence of other outcomes. University of Illinois at Chicago, and Texas Retina Associates. Clinical diagnoses were based on typical choroidal inflammatory lesions associated with vitritis and past or current retinal vasculitis. Inclusion in the study was not dependent on a required length of follow-up. Both eyes were considered for the study if both were implanted. All eligible patients and eyes were included in the study
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