Retisert Indicated for Uveitis?
May 12, 2010
Jancevski, MD and colleagues report on the safety of “Retisert” for patients with intermediate or posterior uveitis. Their study involved 64 eyes of 51 patients.
Retisert (Bausch and Lomb) is an intraocular delivery device that releases a steroid (fluocinolone). The device is implanted in the posterior segment and is anchored by scleral sutures. It does not dissolve.
In their retrospective study, most patients had an elevation of IOP. Half required topical therapy, 14 required laser, trabeculectomy or shunt. 11 of 14 phakic eyes needed cataract surgery.
Vitreous hemorrhage, retinal detachment endophthalmitis and blebitis were other complications.
What Does This Mean? At first glance, Retisert for the management of posterior or intermediate uveitis does not seem a viable treatment. The rise of IOP and complications seem high.
Now consider the ramifications of reducing systemic immunotherapy. The study found that some patients were able to reduce or discontinue immunotherapy. This was noted in 9 patients.
My point is that there seems to be a place for Retisert given the complications of systemic immunosuppressive therapy. For patients not tolerating systemic therapy, local implantation, despite the side effects, may be appropriate.
In the future, with more and more steroid delivery systems emerging (e.g. Iluvien, Ozurdex), the treatment of intermediate uveitis may become more straightforward.
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