Intravitreal steroid slow-release device replacing repeated intravitreal triamcinolone injections for sympathetic ophthalmia

PURPOSE. To report on the intraocular use of a steroid slow-release device in an attempt to avoid multiple intraocular triamcinolone injections in chronic sympathetic ophthalmia. METHODS. A 47-year-old patient with sympathetic ophthalmia had received 17 intravitreal triamcinolone injections to suppress the uveitis, to increase intraocular pressure, and to reduce systemic anti-inflammatory medication. To avoid the frequent reinjections combined with the temporary reduction in vision and potential risk of infection and a recurrence of sympathetic ophthalmia, a slow-release device of 2.1-mg fluocinolone acetonide was intravitreally implanted. RESULTS. During the follow-up of 11 months after the procedure, intraocular pressure stabilized at 12 to 18 mmHg and visual acuity at 0.40 to 0.50. The systemic immunosuppressive therapy was stopped, and consequently, the insulin treatment could be halted. CONCLUSIONS. Despite the limitations of a single case report, the results suggest that an intravitreal slow-release device of fluocinolone may be an alternative to repeatedly administered intravitreal triamcinolone injection for the long-term treatment of sympathetic ophthalmia. The intraocular slow-release application of steroids has enabled patients to live free from diabetic treatment and immunosuppressive medication after 21 years of systemic immunosuppressive therapy with secondary Cushing disease including diabetes mellitus and arterial hypertension. (Eur J Ophthalmol 2008; 18: 834-6)