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Outcomes of Birdshot Chorioretinopathy Treated with an Intravitreal Sustained Release Fluocinolone Acetonide Containing Device

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posted on 27.05.2011 by Ryan B. Rush, Debra A. Goldstein, David G. Callanan, Beeran Meghpara, William J. Feuer, Janet L. Davis
Purpose: To evaluate outcomes in birdshot chorioretinopathy following intravitreal implantation of a fluocinolone acetonide containing drug delivery device. Design: Retrospective, multi-center, interventional case study. Methods: 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. 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. Results: 19 of 22 patients (32 eyes) completed 12 months follow-up with improvement in median visual acuity (P = .015). Prior to implantation,18 of 22 (82%) patients received immunosuppressive therapy vs. 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. 100% of study eyes had ocular hypertension, required intraocular pressure lowering therapy, or had glaucoma surgery by 12 months. Conclusions: 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.

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Funding

This study was supported by National Eye Institute, Bethesda, Maryland, Core Center Grant No. P30 EY014801 (Bascom Palmer Eye Institute, Miami, Florida), and NEI Core Grant for Vision Research P30 EY001792 (University of Illinois at Chicago); and unrestricted funds from Research to Prevent Blindness, New York, New York (Bascom Palmer Eye Institute and University of Illinois at Chicago).

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Publisher Statement

NOTICE: this is the author’s version of a work that was accepted for publication in American Journal of Ophthalmology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in American Journal of Ophthalmology, [VOL 151, ISSUE 4, (April 2011)] DOI: 10.1016/j.ajo.2010.10.005. The original publication is available at www.ajo.com.

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Elsevier

Language

en_US

issn

0002-9394

Issue date

01/04/2011

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