Long-term follow-up of patients treated with multiple fluocinolone acetonide implants for noninfectious uveitis

PURPOSE To evaluate long-term outcomes in eyes undergoing exchange of fluocinolone acetonide intravitreal implants for noninfectious uveitis. METHODS In this retrospective case series, chart review was conducted of all patients treated for noninfectious uveitis with fluocinolone acetonide implants. All patients were seen at a single center between 2007 and 2010.We studied eight eyes of eight patients who received second implants in exchange for previously placed implants and received follow-up care after the implant was exchanged. Main outcome measures were visual acuity (VA), recurrence of inflammation, need for adjunctive systemic anti-inflammatory treatment and adverse events. RESULTS We studied eight eyes of eight patients. Average length of follow-up after the second implant was 32.3 months. Of the eight patients, five experienced improvement or stabilization of VA when acuity prior to the initial implant was compared to acuity on long-term follow-up. After their first implant, five patients experienced disease recurrence. Including all eight patients, the estimated median time to recurrence was 35.7 months after the first implant. The mean time to reimplantation was 42.7 months. After the second implant, three patients experienced recurrence. Including all eight patients, the estimated median time to recurrence was 30.1 months after the second implant. Adverse events included perioperative complications, elevated intraocular pressure (IOP) and cataracts. CONCLUSIONS Exchanging FA intravitreal implants used to treat noninfectious uveitis may be useful in preventing vision loss and recurrence of inflammation. Development of elevated IOP and cataract is a potentially serious complication. The risks and benefits of implant exchange must be carefully considered with this intervention.