Rocky Mountain Lions Eye Institute, Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA.
Retina. 2012 Mar;32(3):537-42. doi: 10.1097/IAE.0b013e31822058bb.
To evaluate the efficacy and safety of the fluocinolone acetonide intravitreal implant in pediatric patients with intractable noninfectious posterior uveitis.
A retrospective chart review was performed on all patients aged <18 years on whom a fluocinolone implant was used to treat intractable posterior uveitis at our institution. Conventional treatment with topical and systemic steroids and/or systemic steroid-sparing agents failed in all patients before proceeding with an implant. Each implant contained 0.59 mg of fluocinolone acetonide. Implants were placed in the inferonasal quadrant through a pars plana incision and sutured in place with 8-0 proline suture. Postoperatively, patients were followed for improvement in Snellen visual acuity, control of inflammation, and development of complications such as infection or uncontrolled intraocular pressure in the eyes.
The study included six eyes of four patients. Mean age at implant placement was 9.2 years (range, 6-13 years). Four eyes were pseudophakic at the time of surgery; one eye had pars plana lensectomy at the time of surgery. Mean follow-up duration was 698 days (range, 376-1,189 days). Postoperative visual acuity improved by ≥3 lines in 3 eyes. Four eyes had postoperative intraocular spikes ≥30 mmHg, with 2 eyes having ≥40 mmHg. Two of these patients required glaucoma shunting procedures postoperatively for intraocular pressure control. Inflammation was well controlled postoperatively in all six eyes with all eyes successfully weaned off of topical steroids. The single phakic eye developed a visually significant cataract 18 months postoperatively requiring cataract extraction. There were no cases of postoperative infection. There were no postoperative complications of surgical technique including no instances of wound leakage or implant dislocation.
The fluocinolone implant can be used effectively for control of posterior inflammation in pediatric patients. As in adults, concerns for development of cataract and secondary glaucoma remain. No other safety concerns were evident in this pilot study.
评估氟轻松醋酸酯玻璃体植入物在患有难治性非感染性后部葡萄膜炎的儿科患者中的疗效和安全性。
对在我院接受氟轻松植入物治疗难治性后部葡萄膜炎的所有年龄<18 岁的患者进行回顾性图表审查。所有患者在接受植入物治疗之前，经传统治疗（包括局部和全身皮质类固醇治疗和/或全身皮质类固醇保留药物治疗）后均无效。每个植入物含有 0.59 毫克氟轻松醋酸酯。通过平面内切口将植入物置于鼻下方象限，并使用 8-0 脯氨酸缝线缝合到位。术后，通过改善视力、控制炎症以及观察眼部感染或眼压失控等并发症的发展情况来评估植入物的疗效。
该研究纳入了 4 名患者的 6 只眼。植入物放置时的平均年龄为 9.2 岁（范围为 6-13 岁）。手术时，4 只眼为人工晶状体眼；1 只眼在手术时行平面内晶状体切除术。平均随访时间为 698 天（范围为 376-1189 天）。术后 3 只眼的视力提高≥3 行。4 只眼术后眼内压升高≥30mmHg，其中 2 只眼的眼内压升高≥40mmHg。这 2 例患者术后均因眼压控制需要行青光眼分流手术。所有 6 只眼的炎症均得到良好控制，所有眼均成功停用局部皮质类固醇。唯一的人工晶状体眼术后 18 个月发生视力显著的白内障，需要行白内障摘除术。无术后感染病例。无手术技术相关并发症，包括无伤口渗漏或植入物移位。
氟轻松植入物可有效用于控制儿科患者的后部炎症。与成人一样，仍需关注白内障和继发性青光眼的发生。在本初步研究中未发现其他安全性问题。
