Purpose: To evaluate the real-world therapeutic efficacy and safety of the novel, long-acting fluocinolone acetonide 0.18-mg injectable intravitreal implant (FAi) in chronic uveitis.
Design: Retrospective case series.
Methods: A retrospective chart review was performed on 103 eyes treated with FAi at a single academic uveitis center including 12 months of postinjection data for each eye. Outcome variables were clinician-defined by fellowship-trained uveitis specialists: ≥2-line visual acuity (VA) improvement, resolution of intraocular inflammation, resolution of macular edema, corticosteroid- and immunotherapy-sparing effect, incidence of cataract surgery, and intraocular pressure (IOP) rise.
Results: 26.1% of eyes had ≥2-line VA improvement by 12 months. All eyes with active intraocular inflammation at injection (n=17) had resolution of activity by month 6. Nearly half of eyes had resolution of macular edema by month 6 (47.5%). Fifty-five percent of patients on oral prednisone and 35% of patients on systemic immunotherapy at baseline were able to discontinue the therapy by month 12. In addition, 6.8% of eyes had IOP rise >10 mm Hg from baseline and 20.4% had ≥2 IOP drops added by month 12. Among the 23 phakic eyes at injection, 30.4% underwent cataract surgery by month 12.
Conclusion: Fluocinolone acetonide was a helpful adjunct for the treatment of chronic uveitis in our real-world cohort. Specifically, FAi showed benefit in the control of active intraocular inflammation and resolution of macular edema when used as an adjunct to systemic immunosuppression. Our cohort had lower rates of steroid-induced increase in IOP as compared to prior clinical trials and incidence of cataract surgery consistent with those published in the literature.
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