title: Evaluation of fluocinolone acetonide sustained release implant (Retisert) dissociation during implant removal and exchange surgery.
abstract: OBJECTIVE
  To characterize the phenomenon of dissociation of the 2 components of the sustained-release fluocinolone acetonide implant (Retisert; Bausch & Lomb) during removal or exchange procedures, or both, and to evaluate outcomes after these events.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  Retrospective review of 27 consecutive sustained-release fluocinolone acetonide implant (Retisert) exchanges or removals between 2001 and 2010 at the Cole Eye Institute. All patients had received the implant as treatment for noninfectious uveitis. Preoperative and postoperative characteristics were analyzed, and operative reports were reviewed to characterize the effects of intraoperative implant dissociation.
  
  
  RESULTS
  Twenty-seven sustained-release fluocinolone acetonide implant (Retisert) exchange or removal surgeries were performed by 3 surgeons in 20 eyes of 19 patients. Of these 27 procedures, dissociation of the implant strut from the drug-containing cup occurred in 11 eyes (40.7%). Retrieval of the dislocated cup led to intraoperative complications, including posterior retinal tear (n = 1) and limited suprachoroidal hemorrhage (n = 1). The length of time that the implant resided in the eye correlated significantly with cup dissociation. Dissociated implants resided a mean of 47.4 months, whereas intact implants resided a mean of 32.5 months (P = .0032). There was no long-term or short-term vision loss attributed to intraoperative implant dissociation.
  
  
  CONCLUSIONS
  Sustained-release fluocinolone acetonide implant (Retisert) dissociation is a common occurrence in exchange or removal procedures, or both. The longer an implant resided in the eye, the greater the tendency toward dissociation. Preparation for this complication should be contemplated in any implant removal or exchange procedure.
authors.affiliation: Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Nicholson
authors.forename: Rishi P
authors.initials: RP
authors.lastname: Singh
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Sears
authors.forename: Careen Y
authors.initials: CY
authors.lastname: Lowder
authors.forename: Peter K
authors.initials: PK
authors.lastname: Kaiser
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal / Q000009:adverse effects*; D004343:Drug Implants; D004868:Equipment Failure; D005260:Female; D005446:Fluocinolone Acetonide / Q000008:administration & dosage*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D015866:Uveitis, Posterior / Q000188:drug therapy; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body
chemical_list: D004343:Drug Implants; D005938:Glucocorticoids; D005446:Fluocinolone Acetonide