Implant therapy, systemic treatment equally effective for uveitis

Ophthalmology. 2011;118(10):1916-1926.

Researchers observed no substantial superiority in fluocinolone acetonide implant therapy vs. systemic corticosteroids plus immunosuppression for the treatment of panuveitis and intermediate or posterior uveitis, according to a study.

The randomized, controlled, parallel superiority trial evaluated data from 479 eyes of 255 patients with active or recently active uveitis. The primary outcome measure was change in best corrected visual acuity from baseline to 24 months; secondary outcome measures included patient-reported quality of life, ophthalmologist-graded uveitis activity, and local and systemic complications of uveitis or therapy.

An improvement in vision-related quality of life was reported as +11.4 units for implant therapy and +6.8 units for systemic therapy (P = .043). A EuroQol-EQ5D health utility change of +0.02 for implant therapy and -0.02 (P = .06) for systemic therapy was observed. Residual active uveitis was measured at 12% for implant therapy and 29% for systemic therapy (P = .001).

Eyes that underwent implant therapy were found to have a significantly higher risk of cataract surgery (80%; P < .0001), interventional treatment of elevated IOP (61%; P < .0001) and glaucoma (17%; P = .0008). More prescription-requiring infections were found among systemic therapy patients than implant therapy patients, but systemic adverse outcomes were otherwise unusual in both groups.

"The specific advantages and disadvantages identified should dictate selection between the alternative treatments in consideration of individual patients' particular circumstances," the study authors said. "Systemic therapy with aggressive use of corticosteroid-sparing immunosuppression was well tolerated, suggesting that this approach is reasonably safe for local and systemic inflammatory disorders."