A surgical implant that releases low doses of a steroid appears to prevent inflammation and stabilize vision in patients with sympathetic ophthalmia. In a retrospective case series, the implant called Retisert has improved the vision of three patients and stabilized it in five.

According to Dr. James Folk of the University of Iowa Hospitals and Clinics, and colleagues, the implant, an approved noninfectious uveitis treatment, is a useful second-line therapy for sympathetic ophthalmia patients who have recurrent inflammation or can’t tolerate systemic anti-inflammatory medications.

From Medpage today:

“Until recently, the primary treatment option for sympathetic ophthalmia was nonsurgical and involved high doses of oral steroids followed by oral immunosuppressive medication to preserve vision in a patient’s remaining eye,” said lead author Vinit Mahajan, M.D., Ph.D., also of the University of Iowa Hospitals and Clinics.

But such systemic treatment, he said in a statement, “subjects patients to life-long use of immunosuppressive drugs that have serious side effects such as osteoporosis, weight gain, potentially life-threatening infection, and liver or kidney damage.”

To evaluate the effects of the implant in cases of sympathetic ophthalmia, the researchers looked at records of eight patients who underwent surgical implantation of the device with post-operative follow-up from three months to two years.

Three of the patients regained vision, the researchers found, probably because of resolution of inflammation and macular edema. Vision was stabilized in the remainder of the patients, and none of them lost vision because of the device or ongoing sympathetic ophthalmia.

The implant contains fluocinolone acetonide and costs about $20,000. This is sutured to the sclera and is good for about two and half years. Since sympathetic ophthalmia is a chronic disease, the implant needs to be replaced after about 2.5 years. Researchers said that this is actually cheaper than long-term immunosuppressive medications and the associated hospital visits.

Tags: Retisert, steroid, surgical implant, sympathetic ophthalmia

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