Prevalence and management of elevated intralocular pressure after placement of an intravitreal sustained-release steroid implant

Purpose of review The fluocinolone acetonide intravitreal implant was approved by the United States Food and Drug Administration in April, 2005 for treatment of noninfectious posterior segment uveitis (NIPU). This therapy is effective with respect to prevention of uveitis recurrence. However, corticosteroid-associated increased intraocular pressure frequently occurs in implanted eyes and must be managed appropriately to prevent glaucomatous vision loss. Recent findings Pooled results from three recent prospective randomized trials show that 75% of eyes receiving the fluocinolone acetonide implant required intraocular pressure (IOP) lowering therapy at some point within the 3-year study course. Eyes requiring surgical intervention had a high rate of hypotony but also showed stable postoperative visual acuity. Summary Fluocinolone acetonide intravitreal implants are an effective therapy for NIPU. However, patients receiving this treatment are at high risk for development of vision-threatening increased IOP. Therefore, we recommend that patients treated with fluocinolone acetonide implants receive frequent IOP monitoring and referral to a glaucoma specialist if pressure control is not achieved.