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. 2012:6:79-85.
doi: 10.2147/OPTH.S24397. Epub 2012 Jan 11.

Post-cataract outcomes in patients with noninfectious posterior uveitis treated with the fluocinolone acetonide intravitreal implant

John D Sheppard Jr  1 , Quan Dong Nguyen, Dale W Usner, Timothy L Comstock
Affiliations

Post-cataract outcomes in patients with noninfectious posterior uveitis treated with the fluocinolone acetonide intravitreal implant

John D Sheppard Jr et al. Clin Ophthalmol. 2012.

Abstract

Purpose: To describe visual acuity (VA) and inflammation following cataract surgery in eyes with noninfectious posterior uveitis (NIPU) that were being treated with a fluocinolone acetonide (FA) intravitreal implant compared with those that were not.

Design: Post hoc, subgroup analysis of data from a 3-year, dose-masked, randomized, multicenter trial evaluating the FA implant for the treatment of NIPU.

Participants and controls: The subset of eyes that underwent cataract surgery during the 3-year trial. Eyes were either implanted with a 0.59- or a 2.1-mg FA implant, or, in the case of affected fellow eyes, received standard-of-care local treatment.

Main outcome measures: VA, anterior and posterior chamber inflammation at 1 and 3 months after surgery, and rate of uveitis recurrence and serious postoperative ocular adverse events.

Results: Of 278 patients enrolled in the main trial, 132/142 phakic implanted eyes and 39/186 phakic non-implanted eyes underwent cataract surgery. Mean improvement in VA was significantly greater in implanted than non-implanted eyes at 1 (P = 0.0047) and 3 months (P = 0.0015) postoperatively; significantly fewer anterior chamber cells were seen in implanted than non-implanted eyes at 1 (P = 0.0084) and 3 months (P = 0.0002). Severity of vitreous haze was less in implanted than non-implanted eyes at 3 months postoperatively (P = 0.0005). The postsurgical uveitis recurrence rate was lower in implanted than non-implanted eyes (26.5% vs 44.4%; P = 0.0433). Glaucoma was reported in 19.7% of implanted eyes and no non-implanted eyes (P = 0.0008) postoperatively.

Conclusion: In this post hoc subgroup analysis, eyes with NIPU treated with the FA intravitreal implant demonstrated better vision and less intraocular inflammation following cataract surgery than non-implanted eyes. Recurrent uveitic inflammation did not appear to be triggered by cataract surgery. Glaucoma occurred more frequently in implanted eyes.

Keywords: cataract surgery; glaucoma; intraocular pressure; posterior chamber inflammation; steroid implant; visual acuity.

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Figures

Figure 1
Figure 1
Uveitis recurrences, which were significantly more likely in non-implanted than implanted eyes (16/36 [44.4%] vs 35/132 [26.5%], P = 0.0433), as a function of time since fluocinolone acetonide implant surgery and cataract extraction surgery. Likelihood of recurrence within 3 months of cataract surgery was greater in non-implanted than implanted eyes; a large proportion of the recurrences documented in implanted eyes occurred more than 2 years after implantation.
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