Bajwa Asima, Aziz Kanza, Foster C Stephen
*Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; †Ocular Immunology & Uveitis Foundation, Cambridge, Massachusetts; and ‡Harvard School of Medicine, Cambridge, Massachusetts.
Retina. 2014 Nov;34(11):2259-68. doi: 10.1097/IAE.0000000000000239.
To report the treatment outcomes of the fluocinolone acetonide intravitreal implant (0.59 mg) in patients with birdshot retinochoroidopathy whose disease is refractory or intolerant to conventional immunomodulatory therapy.
A retrospective case series involving 11 birdshot retinochoroidopathy patients (11 eyes). Eleven patients (11 eyes) underwent surgery for fluocinolone acetonide implant (0.59 mg). Treatment outcomes of interest were noted at baseline, before fluocinolone acetonide implant, and then at 6 months, 1 year, 2 years, 3 years, and beyond 3 years. Disease activity markers, including signs of ocular inflammation, evidence of retinal vasculitis, Swedish interactive threshold algorithm-short wavelength automated perimetry Humphrey visual field analysis, electroretinographic parameters, and optical coherence tomography were recorded. Data on occurrence of cataract and raised intraocular pressure were collected in all eyes.
Intraocular inflammation was present in 54.5, 9.9, 11.1, and 0% of patients at baseline, 6 months, 1 year, 2 years, 3 years, and beyond 3 years after receiving the implant, respectively. Active vasculitis was noted in 36.3% patients at baseline and 0% at 3 years of follow-up. More than 20% (47.61-67.2%) reduction in central retinal thickness was noted in all patients with cystoid macular edema at 6 months, 1 year, 2 years, and 3 years postimplant. At baseline, 54.5% patients were on immunomodulatory agents. This percentage decreased to 45.45, 44.4, and 14.28% at 1 year, 2 years, and 3 years postimplant, respectively. Adverse events included increased intraocular pressure (54.5%) and cataract formation (100%).
The data suggest that fluocinolone acetonide implant (0.59 mg) helps to control inflammation in otherwise treatment-refractory cases of birdshot retinochoroidopathy. It is associated with significant side effects of cataract and ocular hypertension requiring treatment.
报告玻璃体内注射曲安奈德植入物（0.59毫克）治疗难治性或不耐受传统免疫调节疗法的鸟枪弹样视网膜脉络膜病变患者的治疗结果。
一项回顾性病例系列研究，涉及11例鸟枪弹样视网膜脉络膜病变患者（11只眼）。11例患者（11只眼）接受了曲安奈德植入物（0.59毫克）手术。在基线、曲安奈德植入前、然后在6个月、1年、2年、3年及3年以后记录感兴趣的治疗结果。记录疾病活动指标，包括眼部炎症体征、视网膜血管炎证据、瑞典交互式阈值算法 - 短波长自动视野计汉弗莱视野分析、视网膜电图参数和光学相干断层扫描。收集所有眼睛的白内障发生情况和眼压升高数据。
在接受植入物后，基线、6个月、1年、2年、3年及3年以后，分别有54.5%、9.9%、11.1%和0%的患者存在眼内炎症。在基线时，36.3%的患者有活动性血管炎，在随访3年时为0%。所有黄斑囊样水肿患者在植入后6个月、1年、2年和3年时，视网膜中央厚度均减少超过20%（47.61 - 67.2%）。基线时，54.5%的患者使用免疫调节药物。在植入后1年、2年和3年，这一比例分别降至45.45%、44.4%和14.28%。不良事件包括眼压升高（54.5%）和白内障形成（100%）。
数据表明，曲安奈德植入物（0.59毫克）有助于控制鸟枪弹样视网膜脉络膜病变难治性病例中的炎症。它与需要治疗的白内障和高眼压等显著副作用相关。
