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

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.