Retisert implant effective for uveitis, promising for diabetic macular edema and vein occlusion

Chicago-The Retisert implant (Bausch & Lomb), a nonbiogradable device containing fluocinolone acetonide, is approved for the treatment of uveitis and seems promising in diabetic macular edema (DME) and vein occlusion, according to Glenn Jaffe, MD. He reported his experience with the implant on Friday during retina subspecialty day at the American Academy of Ophthalmology annual meeting.

“The advantages of this therapeutic approach are linear drug delivery, the drug is contained within a nontoxic device, and the device is suitable for sustained delivery of the drug for years,” he said. In this case, the expected duration of drug release is 2.5 to 3 years.

Dr. Jaffe is professor of ophthalmology, Duke University, Durham, NC. He evaluated the implant to treat uveitis during an individual investigator (IND) trial in 36 eyes of 32 patients who had severe noninfectious uveitis with posterior segment involvement that was refractory to standard therapy. The average follow-up was 2 years.

“The implant had potent anti-inflammatory effects. Whereas these patients had 2.5 recurrences of uveitis per eye annually, postoperatively there were no recurrences at 2 years and two recurrences at 29 months to 3 years,” Dr. Jaffe reported. Most patients had stabilized or improved visual acuity. The side effects are cataract development and increased IOP. Larger clinical trials of the Retisert implant for uveitis showed results that were similar to Dr. Jaffe’s trial.

The Retisert implant is also being tested to treat DME and as salvage therapy in patients with vein occlusion and appears promising in both cases.

Dr. Jaffe emphasized that tight wound closure is imperative in this procedure to avoid infection and wound leaks and that the patients must be provided with realistic expectations prior to surgery and the possibility of the development of cataract.