Low dose fluocinolone acetonide implant safe in noninfectious uveitis

With relatively low incidence of ocular hypertension necessitating intervention, the 0.18-mg fluocinolone acetonide implant (FAi) appears to be a useful alternative in the therapy of noninfectious uveitis affecting the posterior segment (NIU-PS), says an article published in Ophthalmology Retina. 

In order to describe the effects of the 0.18-mg fluocinolone acetonide implant in the management of noninfectious uveitis, Amit Reddy and colleagues undertook this retrospective cohort study.

Individuals who received the 0.18-mg FAi at the University of Colorado between July 1, 2019, and August 31, 2021 for the treatment of noninfectious uveitis affecting the posterior segment Patients who did not get follow-up care for at least six months following implant implantation were excluded from the study. Age, sex, race/ethnicity, diagnosis of uveitis, past and present use of anti-inflammatory medication, use of short-acting corticosteroid injections within the previous three months prior to the 0.18-mg FAi implantation, visual acuity, intraocular pressure (IOP), grading of anterior chamber and vitreous cell, and presence of cystoid macular edema were all details taken from the patient's medical records. Any heightened inflammation requiring more anti-inflammatory treatment was referred to as a uveitis recurrence.

The key findings of this study were:

There were 64 eyeballs total, from 42 individuals. 

During 6 months and the 12-month follow-up, respectively, the overall chance of remaining recurrence-free was 68.8% and 52.6%. 

The mean age of the eyes that had not had a recurrence at 12 months was lower than that of the eyes that did (P = 0.02). 

By the end of the 6-month follow-up period, eyes that had had a short-acting corticosteroid injection prior to the 0.18-mg FAi were more likely to experience a recurrence (P = 0.05) than eyes that had not. 15.6% of eyes required the beginning or addition of IOP-lowering eyedrops, while 4.7% of eyes required IOP-lowering surgery following 0.18-mg FAi implantation.

Although this may partly be due to selection bias, using short-acting corticosteroid injections before the implantation of the 0.18-mg FAi does not appear to increase the efficacy of the 0.18-mg FAi. To identify the patients who are the best candidates for this treatment, more research is necessary.

Reference: 

Reddy, A. K., Pecen, P. E., Patnaik, J. L., & Palestine, A. G. (2023). Single Institution Experience of Intravitreal 0.18-mg Fluocinolone Acetonide Implant for Noninfectious Uveitis. In Ophthalmology Retina (Vol. 7, Issue 1, pp. 67–71). Elsevier BV. https://doi.org/10.1016/j.oret.2022.07.002