Fluocinolone acetonide intravitreal sustained release device ? a new addition to the armamentarium of uveitic management

Abstract

Uveitis is a potentially sight-threatening infl ammatory eye disease caused by multiple infectious and non-infectious etiologies for which the standard of care involves corticosteroids or various immunomodulary therapy (IMT) drugs. These available treatments, although effective, may cause signifi cant morbidity and sometimes mortality in uveitis patients due to their toxic side-effects and the necessity of long-term therapy to prevent recurrences. In order to avoid the systemic toxicity of corticosteroids and IMT or the repeated injections of local steroids necessary to control ocular infl ammation, and to prevent development of cumulative damage resulting from recurrent episodes of infl ammation, researchers have developed a number of local corticosteroid sustained-release devices that can be implanted directly into the vitreous of the eye, at the site of the infl ammatory disease. Preliminary studies of such a device, the fl uocinolone acetonide (Retisert™) implant, have shown signifi cant reductions in the number of infl ammatory episodes and decreased reliance on systemic corticosteroids or other IMT. This review explores the current research evaluating the fl uocinolone sustained-release intravitreal implant in the treatment of posterior uveitis and the implications for its future use on a wider scale.

Dexamethasone intravitreal implant for the treatment of noninfectious uveitis

“…Instead, fluocinolone acetonide which has 1/20 the solubility of dexamethasone in aqueous and high potency, was used in a small sustained release implant 13. A fluocinolone acetonide (FA) intravitreal implant (Retisert; Bausch & Lomb, Rochester, NY) was the first FDA-approved implantable device for the treatment of severe, noninfectious, posterior uveitis 11,14. This device is surgically placed in the vitreous cavity at the pars plana.…”

New Drugs and New Posterior Delivery Methods in CME

“…The silicone elastomer cup assembly is attached to a PVA suture tab with silicone adhesive. [42–44] Fluocinolone is a corticosteroid with a high potency, low solubility and a very short duration of action in the systemic circulation. [45]…”

Preparation of high specific activity tritium labeled 6α,9,‐difluoro‐11β,21‐dihydroxy‐16α,17‐[(1‐methylethylidene)bis(oxy)]pregna‐1,4‐diene‐3,20‐one, fluocinolone acetonide

“…1 Recent applications include its use as a component in the topical treatment of facial melasma, 2 and in an implantable devices to treat diabetic retinopathy 3 and uveitis. 4 Radiolabeled fluocinolone acetonide labeled with carbon-14 in the acetonide moiety was used for distribution studies in mice 5 and for metabolism studies in man. 6 Tritium labeled fluocinolone acetonide does not appear to have been reported.…”