Combined fluocinolone acetonide intravitreal insertion and glaucoma drainage device placement for chronic uveitis and glaucoma.
OBJECTIVE
To determine whether a fluocinolone acetonide sustained-release intravitreal drug delivery system can be implanted safely at the same time that a glaucoma drainage device is placed for eyes with uveitis and elevated intraocular pressure (IOP) receiving maximum tolerated IOP-lowering therapy.


METHODS
Retrospective, observational case series.


METHODS
Subjects had chronic noninfectious intermediate or posterior uveitis and elevated IOP while receiving maximum tolerated medical therapy. Fluocinolone acetonide implantation and glaucoma tube shunt placement were performed in a single surgical session. The main outcome measures were inflammatory recurrences, visual acuity (VA), use of adjunctive anti-inflammatory therapy, IOP, and adverse events.


RESULTS
Seven eyes of 5 patients were studied. The average number of recurrences 12 months before implantation was 3 episodes per eye; of the 3 eyes followed up for more than 30 months, none had an inflammatory recurrence within 30 months after implantation. The mean Snellen visual acuity 12 months after the combined surgery was 20/114, compared with 20/400 at baseline. Adjunctive steroid use decreased. Average IOP decreased from 27.3 mm Hg at baseline to 14.6 mm Hg 12 months after the combined surgery (P = .019).


CONCLUSIONS
The favorable results observed in all eyes suggest that fluocinolone acetonide implantation can be safely combined with glaucoma tube shunt placement in a single surgical session in eyes with uveitis and elevated IOP receiving maximum tolerated IOP-lowering therapy. Uveitis recurrences decreased, visual acuity improved, and IOP decreased. There were no adverse events during insertion of the fluocinolone acetonide implant and placement of the glaucoma tube shunt.
Malone
Paula E
PE
Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA.
Herndon
Leon W
LW
Muir
Kelly W
KW
Jaffe
Glenn J
GJ
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004343:Drug Implants; D005240:Feasibility Studies; D005260:Female; D005446:Fluocinolone Acetonide / Q000008:administration & dosage*; D005901:Glaucoma / Q000209:etiology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D015867:Uveitis, Intermediate / Q000150:complications / Q000188:drug therapy*; D015866:Uveitis, Posterior / Q000150:complications / Q000188:drug therapy*; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body
D004343:Drug Implants; D005938:Glucocorticoids; D005446:Fluocinolone Acetonide