Research Digest

■ FA Implants for Treatment of Posterior Uveitis

A study evaluating the safety and efficacy of 0.59-mg and 2.1mg fluocinolone acetonide (FA) intravitreous implant in noninfectious posterior uveitis found that it "significantly reduced uveitis recurrence and improved or stabilized VA in patients with noninfectious posterior uveitis (NIPU)."¹

Researchers studied the 0.59mg FA intravitreous implant in 110 patients and the 2.1mg FA intravitreous implant in 168 patients at 27 clinical centers (26 in the United States and one in Singapore). Patients with both unilateral and bilateral uveitis were included. It was a 3-year, randomized, historically controlled trial. Outcome measures were recurrence rate, vision and complications.

Subjects were randomized in a ratio of 2:3 to receive either the 0.59mg or 2.1mg FA implant. Other uveitis medications were tapered following implantation. Follow-up visits occurred at day 1 after implantation, then at weeks 1, 4, 8, 12, 18, 24, 30, 34 and 52, and then every 3 months through year 3. Assessments included applanation tonometry, slit-lamp biomicroscopy, indirect ophthalmoscopy, automated visual field testing, hematology, serum chemistry testing, and BCVA as measured by the protocol developed for the Early Treatment Diabetic Retinopathy Study.

Additionally, patients underwent fluorescein angiography at screening, week 8, week 34, 1 year, 2 years and 3 years, with evaluation of macular hyperfluoescence under a protocol developed by the Retinal Diseases and Image Analysis Center, Case Western University, Cleveland.

Researchers found that recurrence of uveitis was reduced in implanted eyes from 62% (during the 1-year pre-implantation period) to 4%, 10%, and 20% during the 1-, 2- and 3-year postimplantation periods, respectively, for the 0.59mg dose group (P<.01).

For the 2.1mg dose group (P<.01), recurrence dropped from 58% to 7%, 17% and 41%, respectively. Implanted eyes showed higher incidences of elevated IOP (≥ 10mm Hg) than nonimplanted eyes (P<.01); glaucoma surgery was required in 40% of implanted eyes vs. 2% of nonimplanted eyes (P<.01). Cataracts were removed from 93% of phakic implanted eyes compared with 20% of phakic nonimplanted eyes. "The results from this study demonstrate that the FA intravitreous implant is highly effective in controlling inflammation secondary to NIPU," investigators wrote. OM

Reference

1. Callanan DG, Jaffe GJ, Martin DF, Pearson PA, Comstock TL. Treatment of posterior uveitis with a fluocinolone acetonide implant. Arch Ophthalmol. Sept. 2008; 126:1191-1201.

■ Retinal Detachment After Phaco in Highly Myopic Eyes

German researchers examined 2,356 eyes to determine the incidence of and risk factors for rhegmatogenous retinal detachment (RD) in highly myopic eyes following cataract surgery.¹

The retrospective medical-chart review involved 1,519 consecutive patients (2,356 eyes) at two ophthalmology centers in Germany, at Munich and Anhaus. The eyes had an axial length (AL) > 27.0mm and underwent planned phacoemulsification and IOL implantation in the capsular bag. All patients and/or the referring ophthalmologist were contacted regarding the occurrence of RD and laser capsulotomy, and the date of occurrence.

Follow-up was more than 24 months in 84% of the eyes. The researchers found that gender, history of laser capsulotomy and increasing AL had no statistically significant effect on the rate of retinal detachment. They found that "because some cases of RD were questionably related to the preceding cataract surgery, the absolute incidence of postoperative RD was determined as" 1.5% to 2.2%. The risk of postoperative RD was higher for younger eyes, as well as eyes with preoperative prophylactic treatment for retinal degeneration.

"The risk profile for postoperative RD in this series cannot be distinguished from the risk profile for idiopathic RD in myopia of this extent," the authors wrote. OM

Reference

1. Neuhann IM, Neuhann TF, Heimann H, Schmickler S, Gerl RH, Foerster MH. Retinal detachment after phacoemulsification in high myopia: analysis of 2,356 cases. JCRS. Oct. 2008; 34):1644-1657.