Pars plana vitrectomy, fluocinolone acetonide implantation, and silicone oil infusion for the treatment of chronic, refractory uveitic hypotony.

Abstract

PURPOSE:

To assess the feasibility and outcomes of combining fluocinolone acetonide sustained drug delivery implant insertion, pars plana vitrectomy, and silicone oil infusion to treat patients with chronic, refractory ocular hypotony resulting from uveitis.

DESIGN:

Retrospective chart review.

METHODS:

A retrospective, institutional chart review was performed. Outcome measures included visual acuity, intraocular pressure, and adverse events.

RESULTS:

A total of 13 eyes of 11 patients were studied. All patients were women, had a mean age of 57 years (range, 26 to 73 years), and had a diagnosis of panuveitis. The mean duration of preoperative hypotony was 42 months (range, 11 to 108 months). Patients were followed up on average for 22 months (range, 9 to 46 months) after the combined surgical procedure. The mean preoperative visual acuity was 20/1000 (logarithm of the minimal angle of resolution, 1.7). At the 6- and 12-month visits, the mean visual acuity remained stable at 20/800 (logarithm of the minimal angle of resolution, 1.6; P = .74) and 20/600 (P = .34), respectively. At baseline, the mean intraocular pressure (IOP) was 2.3 mm Hg. The average IOP was 5.9 mm Hg, 5.1 mm Hg, and 5.0 mm Hg at 6, 12, and 24 months after surgery, respectively. The increase in IOP relative to the baseline IOP was statistically significant at 6 and 12 months (P = .027 and P = .004, respectively). The duration of preoperative hypotony inversely correlated with the IOP at 6 months (P = .027). No intraoperative complications were encountered and the procedure was well tolerated.

CONCLUSIONS:

Fluocinolone acetonide implantation combined with pars plana vitrectomy and silicone oil infusion is feasible and is well tolerated in the management of chronic, refractory ocular hypotony associated with uveitis.

• Authors: Pouya N Dayani, Jessica Chow, Sandra S Stinnett, Glenn J Jaffe
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 152 Issue 5 Pg. 849-56.e1 (Nov 2011) ISSN: 1879-1891 [Electronic] United States
• PMID: 21794844 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Chemical References

• Drug Implants
• Glucocorticoids
• Silicone Oils
• Fluocinolone Acetonide

Topics

• Adult
• Aged
• Chronic Disease
• Combined Modality Therapy
• Drug Implants
• Female
• Fluocinolone Acetonide (administration & dosage)
• Follow-Up Studies
• Glucocorticoids (administration & dosage)
• Humans
• Intraocular Pressure (physiology)
• Middle Aged
• Ocular Hypotension (drug therapy, etiology, surgery, therapy)
• Recurrence
• Retrospective Studies
• Silicone Oils (administration & dosage)
• Tonometry, Ocular
• Uveitis (complications, drug therapy, surgery, therapy)
• Visual Acuity (physiology)
• Vitrectomy
• Vitreous Body