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Download fileOutcomes of Birdshot Chorioretinopathy Treated with an Intravitreal Sustained Release Fluocinolone Acetonide Containing Device
journal contribution
posted on 27.05.2011, 00:00 authored by Ryan B. Rush, Debra A. Goldstein, David G. Callanan, Beeran Meghpara, William J. Feuer, Janet L. DavisPurpose: 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.