- Email: [email protected]
Re: Jaffe et al.: Injectable fluocinolone acetonide long-acting implant for noninfectious intermediate uveitis, posterior uveitis, and panuveitis: two-year results (Ophthalmology. 2016;123:1940-1948)
Correspondence Re: Jaffe et al.: Injectable fluocinolone acetonide long-acting implant for noninfectious intermediate uveitis, posterior uveitis, and panuveitis: two-year results (Ophthalmology. 2016;123:1940-1948) 1 TO THE EDITOR: I read with interest the article by Jaffe et al on injectable fluocinolone implant for noninfectious uveitis and would appreciate more details about the 2 doses of fluocinolone implant used in this study, the size of the implant, and the rationale behind using 2 different doses. Were any complications encountered when injecting the fluocinolone implant, for instance, difficulty penetrating the sclera or malposition within the eye? It would also be interesting to know the location of the implant after the injection and what happens to the implant over the period of 2 years.
RUPESH AGRAWAL, MD, FRCS National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore Financial Disclosures: The author has no proprietary or commercial interest in any materials discussed in this article. Correspondence: Rupesh Agrawal, MD, FRCS, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433. E-mail: rupesh_agrawal@ ttsh.com.sg.
efficacy. Accordingly, the lowest effective clinical dose was not known. However, both implants had a relatively high incidence of increased intraocular pressure. To minimize the chance of elevated intraocular pressure, in the author’s individual investigator trial of the injectable fluocinolone acetonide implant described in the present report, release rates were chosen to be lower than those in the lower dose surgically implanted system. The release rate of the high-dose injectable system was approximately equal to the low end of that released by the surgically placed implant (0.4 mg/d), and the low-dose implant had a release rate approximately onehalf that of the high-dose injectable implant (0.2 mg/d). As described in the current report, both these doses effectively controlled inflammation with a lower incidence of intraocular pressure elevation than was observed with the surgically implanted system. No complications were encountered related to the implant injection procedure itself. Penetration through the sclera sometimes required firm pressure on the syringe, but the injection was tolerated similarly to that of a standard intraocular injection through a 30-gauge needle (e.g., that used for an intravitreal antivascular endothelial growth factor or corticosteroid injection). Typically, the implant settled in the inferior vitreous base after insertion. To date, we have not observed it in the mid-vitreous cavity beyond a day after the initial injection. We are currently collecting data on implants that have been in place for >2 years, and plan to report those data once a sufficient number of eyes have been followed over a longer period of time.
GLENN J. JAFFE, MD
Reference 1. Jaffe GJ, Lin P, Keenan RT, et al. Injectable fluocinolone acetonide long-acting implant for noninfectious intermediate uveitis, posterior uveitis, and panuveitis: two-year results. Ophthalmology. 2016;123:1940-1948. We appreciate Dr Agrawal’s interest in our article.1 In response to his questions, the high- and low-dose implants each were 3.5 mm in length, and 0.3 mm in diameter. In the original studies of the surgically implanted fluocinolone implant (Retisert, Bausch & Lomb, Rochester, NY), a low- and high-dose implant was also evaluated, one that released, on average approximately 0.6 mg/d, and a minimum of 0.4 mg/d, and one that released approximately 2 mg/d, respectively. Both implants controlled inflammation and had essentially the same REPLY:
Department of Ophthalmology, Duke University, Durham, North Carolina Financial Disclosures: The author has no proprietary or commercial interest in any materials discussed in this article. Correspondence: Glenn J. Jaffe, MD, Duke Eye Center, 2351 Erwin Road, Durham, NC 27705. E-mail: [email protected].
Reference 1. Jaffe GJ, Lin P, Keenan RT, et al. Injectable fluocinolone acetonide long-acting implant for noninfectious intermediate uveitis, posterior uveitis, and panuveitis: two-year results. Ophthalmology. 2016;123:1940-1948.
e45
RUPESH AGRAWAL, MD, FRCS National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore Financial Disclosures: The author has no proprietary or commercial interest in any materials discussed in this article. Correspondence: Rupesh Agrawal, MD, FRCS, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433. E-mail: rupesh_agrawal@ ttsh.com.sg.
efficacy. Accordingly, the lowest effective clinical dose was not known. However, both implants had a relatively high incidence of increased intraocular pressure. To minimize the chance of elevated intraocular pressure, in the author’s individual investigator trial of the injectable fluocinolone acetonide implant described in the present report, release rates were chosen to be lower than those in the lower dose surgically implanted system. The release rate of the high-dose injectable system was approximately equal to the low end of that released by the surgically placed implant (0.4 mg/d), and the low-dose implant had a release rate approximately onehalf that of the high-dose injectable implant (0.2 mg/d). As described in the current report, both these doses effectively controlled inflammation with a lower incidence of intraocular pressure elevation than was observed with the surgically implanted system. No complications were encountered related to the implant injection procedure itself. Penetration through the sclera sometimes required firm pressure on the syringe, but the injection was tolerated similarly to that of a standard intraocular injection through a 30-gauge needle (e.g., that used for an intravitreal antivascular endothelial growth factor or corticosteroid injection). Typically, the implant settled in the inferior vitreous base after insertion. To date, we have not observed it in the mid-vitreous cavity beyond a day after the initial injection. We are currently collecting data on implants that have been in place for >2 years, and plan to report those data once a sufficient number of eyes have been followed over a longer period of time.
GLENN J. JAFFE, MD
Reference 1. Jaffe GJ, Lin P, Keenan RT, et al. Injectable fluocinolone acetonide long-acting implant for noninfectious intermediate uveitis, posterior uveitis, and panuveitis: two-year results. Ophthalmology. 2016;123:1940-1948. We appreciate Dr Agrawal’s interest in our article.1 In response to his questions, the high- and low-dose implants each were 3.5 mm in length, and 0.3 mm in diameter. In the original studies of the surgically implanted fluocinolone implant (Retisert, Bausch & Lomb, Rochester, NY), a low- and high-dose implant was also evaluated, one that released, on average approximately 0.6 mg/d, and a minimum of 0.4 mg/d, and one that released approximately 2 mg/d, respectively. Both implants controlled inflammation and had essentially the same REPLY:
Department of Ophthalmology, Duke University, Durham, North Carolina Financial Disclosures: The author has no proprietary or commercial interest in any materials discussed in this article. Correspondence: Glenn J. Jaffe, MD, Duke Eye Center, 2351 Erwin Road, Durham, NC 27705. E-mail: [email protected].
Reference 1. Jaffe GJ, Lin P, Keenan RT, et al. Injectable fluocinolone acetonide long-acting implant for noninfectious intermediate uveitis, posterior uveitis, and panuveitis: two-year results. Ophthalmology. 2016;123:1940-1948.
e45