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Evaluation of fluocinolone acetonide 0.19 mg intravitreal implant in the management of birdshot retinochoroiditis
  1. Sofia Ajamil-Rodanes1,
  2. Ilaria Testi1,
  3. Joshua Luis1,
  4. Anthony G Robson2,3,
  5. Mark Westcott1,3,
  6. Carlos Pavesio1,3
  1. 1 Medical Retina and Uveitis Department, Ophthalmology Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2 Electrophysiology Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  3. 3 Institute of Ophthalmology, University College London, London, London
  1. Correspondence to Sofia Ajamil-Rodanes, Ophthalmology Department, Moorfields Eye Hospital NHS Foundation Trust, 162 City Rd, Old Street, London, UK; sofia.ajamil{at}gmail.com

Abstract

Purpose To report treatment outcomes and efficacy of the fluocinolone acetonide 0.19 mg intravitreal implant (Iluvien) in controlling retinal and choroidal inflammation in 11 patients with birdshot retinochoroiditis.

Methods A single-centre, retrospective, interventional case series. The primary efficacy end point was improvement in vascular leakage on fluorescein angiography (FA), effect on cystoid macular oedema (CMO) and resolution of hypofluorescent lesions on indocyanine green angiography (ICGA); secondary measures were improvements on pattern and full-field electroretinogram (PERG; ERG) parameters. Safety outcome measures were intraocular elevation and cataractogenesis.

Results Fifteen eyes received Iluvien implant with an average follow-up of 31 months (range 12–36 months). Prior to the implant, 5 (33.3%) eyes had received dexamethasone intravitreal implant 0.7 mg (Ozurdex). FA showed evidence of vascular leakage in all eyes at baseline. Between month 6 and 12, FA showed that 73.4% of eyes had no leakage, this increased to 84.6% by month 24. Three eyes in our study had CMO at baseline. 6 months after Iluvien implant, all eyes achieved complete CMO resolution. One year after insertion of the implant, the characteristic hypofluorescent lesions on ICGA were unchanged in all cases. There was baseline ERG evidence indicating a high incidence of peripheral cone system dysfunction and most showed PERG evidence of macular dysfunction. Retinal function improved and macular function improved or was stable in the majority following treatment.

Conclusions The results show the possible therapeutic effect of Iluvien in the management of Birdshot-related vascular leakage, CMO and retinal dysfunction. However, choroidal lesions seem to persist with no detectable response to treatment.

  • Choroid
  • Retina
  • Inflammation
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Footnotes

  • Acknowledgement This research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. AGR is supported by the NIHR Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology and by the Moorfields Eye Charity.

  • Contributors SA-R performed data collection and wrote the manuscript with input from all authors. All authors contributed to literature review and preparation of the manuscript. MW, CP and AGR provided the concept and design, intellectual content and critical review of the manuscript.

  • Funding None.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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