Outcomes of Birdshot Chorioretinopathy Treated with an Intravitreal Sustained Release Fluocinolone Acetonide Containing Device
journal contributionposted on 27.05.2011 by Ryan B. Rush, Debra A. Goldstein, David G. Callanan, Beeran Meghpara, William J. Feuer, Janet L. Davis
Any type of content formally published in an academic journal, usually following a peer-review process.
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.