Post-cataract outcomes in patients with noninfectious posterior uveitis treated with the fluocinolone acetonide intravitreal implant

Abstract

Purpose

To describe visual acuity (VA) and inflammation following cataract surgery in eyes with noninfectious posterior uveitis (NIPU) that were being treated with a fluocinolone acetonide (FA) intravitreal implant compared with those that were not.

Design

Post hoc, subgroup analysis of data from a 3-year, dose-masked, randomized, multicenter trial evaluating the FA implant for the treatment of NIPU.

Participants and controls

The subset of eyes that underwent cataract surgery during the 3-year trial. Eyes were either implanted with a 0.59- or a 2.1-mg FA implant, or, in the case of affected fellow eyes, received standard-of-care local treatment.

Main outcome measures

VA, anterior and posterior chamber inflammation at 1 and 3 months after surgery, and rate of uveitis recurrence and serious postoperative ocular adverse events.

Results

Of 278 patients enrolled in the main trial, 132/142 phakic implanted eyes and 39/186 phakic non-implanted eyes underwent cataract surgery. Mean improvement in VA was significantly greater in implanted than non-implanted eyes at 1 (P = 0.0047) and 3 months (P = 0.0015) postoperatively; significantly fewer anterior chamber cells were seen in implanted than non-implanted eyes at 1 (P = 0.0084) and 3 months (P = 0.0002). Severity of vitreous haze was less in implanted than non-implanted eyes at 3 months postoperatively (P = 0.0005). The postsurgical uveitis recurrence rate was lower in implanted than non-implanted eyes (26.5% vs 44.4%; P = 0.0433). Glaucoma was reported in 19.7% of implanted eyes and no non-implanted eyes (P = 0.0008) postoperatively.

Conclusion

In this post hoc subgroup analysis, eyes with NIPU treated with the FA intravitreal implant demonstrated better vision and less intraocular inflammation following cataract surgery than non-implanted eyes. Recurrent uveitic inflammation did not appear to be triggered by cataract surgery. Glaucoma occurred more frequently in implanted eyes.

Keywords:

• cataract surgery
• posterior chamber inflammation
• glaucoma
• intraocular pressure
• visual acuity
• steroid implant

Acknowledgments

This research was sponsored by Bausch and Lomb Incorporated, Rochester, NY. The sponsor participated in the design of the study; conducting the study; data collection, management, and analysis; interpretation of the data; and preparation, review, and approval of the manuscript. We would like to thank Richa Attre, PhD, for her assistance in preparing the manuscript.

Fluocinolone Acetonide Uveitis Study Group Principal Investigators

Rajiv Anand, MD, Dallas, TX; Brian Berger, MD, Austin, TX; David Callanan, MD, Arlington, TX; Kakarla V Chalam, MD, Jacksonville, FL; Janet L Davis, MD, Miami, FL; Pravin U Dugel, MD, Phoenix, AZ; JP Dunn Jr, MD, Baltimore, MD; C Stephen Foster, MD, Boston, MA; William Freeman, MD, La Jolla, CA; Debra A Goldstein, MD, Chicago, IL; Allen Ho, MD, Philadelphia, PA; Glenn J Jaffe, MD, Durham, NC; Baruch Kuppermann, MD, PhD, Irvine, CA; Paul Latkany, MD, New York, NY; Careen Y Lowder, MD, PhD, Cleveland, OH; Daniel F Martin, MD, Atlanta, GA; Pauline Merrill, MD, Chicago, IL; Ramana Moorthy, MD, Indianapolis, IN; Lawrence Morse, MD, PhD, Davis, CA; Stuart Noorily, MD, Teaneck, NJ; Peter Pavan, MD, Tampa, FL; Chee Soon Phaik, MD, Singapore; Michael B Raizman, MD, Boston, MA; James T Rosenbaum, MD, Portland, OR; John D Sheppard Jr, MD, Norfolk, VA; Russell van Gelder, MD, PhD, St Louis, MO; Albert Vitale, MD, Salt Lake City, UT.

Data and safety monitoring committee members

Alexander Brucker, MD, Philadelphia, PA (Chair); Theodore Colton, ScD, Boston, MA; Karen Gehrs, MD, Iowa City, IA; Lee Jampol, MD, Chicago, IL; Mark Johnson, MD, Ann Arbor, MI; Robert Levine, MD, New Haven, CT; David Musch, PhD, Ann Arbor, MI.

Disclosures

No conflicting relationship exists for any author except Dale W Usner, who was employed, and Timothy L Comstock, who is employed, by Bausch and Lomb Incorporated, Rochester, NY. John D Sheppard Jr and Quan Dong Nguyen are consultants to Bausch and Lomb Inc, Rochester, NY.