J Rheum Dis.  2013 Apr;20(2):123-126. 10.4078/jrd.2013.20.2.123.

A Case of Refractory Behcet's Uveitis Improving after Insertion of Fluocinolone Acetonide Implant

• Kim YS
• Choi JR
• Kim SW
• Kim HS

• KMID: 2223038
• DOI: http://doi.org/10.4078/jrd.2013.20.2.123

Abstract

Behcet's disease (BD) is systemic vasculitis that can manifest severely debilitating. Despite the understanding mechanisms of overall BD, there are remains many questions in various critical manifestations and treatments. The ocular manifestation is characterized by a prototype of chronic relapsing and persistent uveitis. The main treatment is topical corticosteroid, and topical nonsteroidal anti-inflammatory drugs in mild uveitis. The recurrent and severe uveitis could be treated with ocular corticosteroid injections, and systemic corticosteroid for inducing long-lasting suppression of the inflammation. Systemic corticosteroids should rapidly be tapered within weeks for avoiding side effects. Recent advances have led to the development of sustained-release corticosteroid devices using different corticosteroids. We present a case of 67-year-old woman who received a fluocinolone acetonide implant for recurrent Behcet's uveitis. She was successfully treated with implant and the uveitis became quiescent within a month.

Keyword

Behcet's disease; Uveitis; Fluocinolone acetonide implant

MeSH Terms

Adrenal Cortex Hormones
Female
Fluocinolone Acetonide
Humans
Inflammation
Systemic Vasculitis
Uveitis
Adrenal Cortex Hormones
Fluocinolone Acetonide

Figure

• 

  Figure 1. The fundus photograph in Behç et's uveitis. (A) The vitreous haziness and previous photocoagulation showed at initial visit. (B) The vitreous haziness improved after treatment of infliximab. (C) The haziness resolved completely after fluocinolone acetonide implant insertion.

Reference

References

1. Evereklioglu C. Current concepts in the etiology and treatment of Behç et disease. Surv Ophthalmol. 2005; 50:297–350.

2. Evereklioglu C. Ocular Behç et disease: current therapeutic approaches. Curr Opin Ophthalmol. 2011; 22:508–16.

3. Sallam A, Taylor SR, Lightman S. Review and update of intraocular therapy in noninfectious uveitis. Curr Opin Ophthalmol. 2011; 22:517–22.

4. Kim NK, Park MY, Lee JH, Lee DH, Yoon BY. Uveitis and rheumatic diseases in a community based practice - Korean population. J Rheum Dis. 2011; 18:276–82.

5. Kim JJ, Kim TH. Uveitis in rheumatic diseases. J Rheum Dis. 2012; 19:1–3.

6. Pato E, Muñ oz-Fernández S, Francisco F, Abad MA, Maese J, Ortiz A, et al. Uveitis Working Group from Spanish Society of Rheumatology. Systematic review on the effectiveness of immunosuppressants and biological therapies in the treatment of autoimmune posterior uveitis. Semin Arthritis Rheum. 2011; 40:314–23.

7. Kok H, Lau C, Maycock N, McCluskey P, Lightman S. Outcome of intravitreal triamcinolone in uveitis. Ophthalmology. 2005; 112:1916.e1-7.

8. Nguyen QD, Callanan D, Dugel P, Godfrey DG, Goldstein DA, Wilensky JT. Treating chronic noninfectious posterior segment uveitis: the impact of cumulative damage. Proceedings of an expert panel roundtable discussion. Retina. 2006; (Suppl):1–16.

9. Pavesio C, Zierhut M, Bairi K, Comstock TL, Usner DW. Fluocinolone Acetonide Study Group. Evaluation of an intravitreal fluocinolone acetonide implant versus standard systemic therapy in noninfectious posterior uveitis. Ophthalmology. 2010; 117:567–75.

10. Allen RC, Suhler EB, Flaxel CJ, Chen Z, Choi D. Longterm followup of patients treated with multiple fluocinolone acetonide implants for noninfectious uveitis. J Ophthalmic Inflamm Infect. 2012; 2:177–82.

11. Lee EJ, Yu HG. A case of Retiserttrade mark implant for Chronic Behcet's Panuveitis. J Korean Ophthalmol Soc. 2008; 49:1007–12.

12. Callanan DG, Jaffe GJ, Martin DF, Pearson PA, Comstock TL. Treatment of posterior uveitis with a fluocinolone acetonide implant: three-year clinical trial results. Arch Ophthalmol. 2008; 126:1191–201.

13. Jaffe GJ, Martin D, Callanan D, Pearson PA, Levy B, Comstock T. Fluocinolone Acetonide Uveitis Study Group. Fluocinolone acetonide implant (Retisert) for noninfectious posterior uveitis: thirty-four-week results of a multicenter randomized clinical study. Ophthalmology. 2006; 113:1020–7.

14. Galor A, Margolis R, Kaiser PK, Lowder CY. Vitreous band formation and the sustained-release, intravitreal fluocinolone (Retisert) implant. Arch Ophthalmol. 2007; 125:836–8.

15. Ramaiya KJ, Rao PK. Herpetic necrotizing retinitis following flucinolone acetonide intravitreal implant. Ocul Immunol Inflamm. 2011; 19:72–4.