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Macular Diseases

Hypotony Maculopathy Associated With Extruded Fluocinolone Acetonide Intravitreal Implant

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JAMA Ophthalmology

Published Online: August 17, 2023

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Article Information and Disclosures

Matias Soifer, MD¹;

Ryan Leite, MS^1,2;

Shilpa Kodati, MD^1,3

Author Affiliations

¹National Eye Institute, National Institutes of Health, Bethesda, Maryland
²School of Medicine, Georgetown University, Washington, DC
³Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor

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A patient in their late sixties with advanced and active birdshot chorioretinopathy who underwent placement of a fluocinolone acetonide, 0.59 mg, intravitreal implant (Retisert; Bausch and Lomb) in their right eye 9 years ago and was receiving prednisone, mycophenolate mofetil, and infliximab-dyyb treatment presented with painless, decreased vision in the right eye. They denied any history of trauma or other ocular symptoms. Best-corrected visual acuity (VA) was 20/500 OD and 20/20 OS, and intraocular pressure (IOP) was 2 mm Hg and 14 mm Hg in the right and left eye, respectively. Examination revealed extrusion of the fluocinolone acetonide intravitreal implant (Figure, A), 2+ anterior-chamber cell,¹ 1+ vitreous cell,² and diffuse chorioretinal folds (Figure, B). The patient underwent pars plana vitrectomy with explantation of the implant. Two months later, VA with pinhole improved to 20/50 OD, IOP increased to 11 mm Hg, the anterior-segment and vitreous inflammation had resolved, and chorioretinal folds improved. This case highlights the fact that spontaneous fluocinolone acetonide intravitreal implant extrusion can rarely occur.

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Article Information

Corresponding Author: Shilpa Kodati, MD, Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall St, Ann Arbor, MI 48105 (shko@umich.edu).

Conflict of Interest Disclosures: None reported.

Funding/Support: This case report was supported by the National Institutes of Health intramural research program.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References

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Kempen JH , Altaweel MM , Holbrook JT , Jabs DA , Sugar EA ; Multicenter Uveitis Steroid Treatment Trial Research Group. The multicenter uveitis steroid treatment trial: rationale, design, and baseline characteristics. Am J Ophthalmol. 2010;149(4):550-561.e10. doi:10.1016/j.ajo.2009.11.019 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.