Evaluating Two Challenging Cases
Evaluating Two Challenging Cases
In the following cases, Retisert® (fluocinolone acetonide intravitreal implant 0.59 mg) brought chronic posterior uveitis under control and returned vision to what may be the best level anatomically possible due to cumulative damage from chronic recurrent inflammation. Since implantation, neither patient has required additional medication to control intraocular inflammation.
Under the care of another physician, Patient One had been taking oral corticosteroids for quite some time, not tolerating them well, and her visual acuity had continued to deteriorate. VA was counting fingers in the right eye and 20/50 in the left eye. Fluorescein angiography showed bilateral subtle leakage due to multifocal choroiditis with panuveitis.
The patient underwent Retisert implantation in both eyes, which reduced the amount of leakage visible on angiography (Figures 1-4). Subsequently, she had cataract surgery with IOL implantation and IOP-lowering surgery in both eyes, to which she responded well.
Figures 1-4. Right and left eyes of a patient implanted with Retisert to control multifocal choroiditis with panuveitis. Note the reduced leakage on fluorescein angiography.
At the most recent follow-up visit, VA was 20/50 in the right eye and 20/20 in the left eye. Damage likely caused by inadequate control of inflammation by oral steroids may not allow further vision improvement in the right eye.
Patient Two had been taking oral corticosteroids to combat punctate inner choroidopathy, which can be an aggressively recurring condition. Vision in the right eye continued to deteriorate and was 20/200 upon presentation. Fluorescein angiography revealed light leakage, but color fundus photography showed soft-edged, obviously active, lesions.
Retisert implantation quieted the lesions, and VA improved to 20/25 (Figures 5-8).
Figures 5-8. Right eye of a patient with punctate inner choroidopathy before and after Retisert implantation. Leakage from formerly active lesions was reduced as evidenced by the now distinct borders.
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Retinal Physician, Issue: March 2011