Posterior uveal cleft and hypotony complicating insertion of a fluocinolone acetonide implant

Sirichai Pasadhika, Justine R. Smith, Christina Flaxel

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: To describe posterior uveal cleft and chronic hypotony occurring in association with a fluocinolone acetonide implant (Retisert) that was successfully treated by vitrectomy, removal of the implant, and cryotherapy. Methods: A 57-year-old female patient with idiopathic uveitis, well-controlled with cyclosporine, developed chronic hypotony with maculopathy after insertion of a fluocinolone acetonide implant. Visual acuity in the affected eye was counting fingers, and intraocular pressure was 0 mmHg. Wound leakage, cyclodialysis cleft, and cyclitic membrane were excluded. Ultrasound biomicroscopy demonstrated a posterior uveal cleft at the site of implant, which was presumed to have created a channel for passage of intraocular fluid to the suprachoroidal space. The patient was treated with pars plana vitrectomy, removal of the implant, cryotherapy at the implant site, and intravitreal triamcinolone acetonide injection. Results: The procedure was well tolerated. Intraoperative appearance suggested incarceration of the implant, which did not show on ultrasound biomicroscopy. Intraocular pressure was normalized 5 days after the surgery. Postoperative visual acuity improved to 20/200 at 2 weeks after the surgery and remained stable through 1 year of follow-up. Uveitis remains well controlled with cyclosporine at 1 year after the procedure. Conclusion: Posterior uveal cleft may cause hypotony as a complication of insertion of a fluocinolone acetonide implant. The ultrasound biomicroscopy is a crucial investigation to establish the diagnosis and to exclude other pathologies including cyclodialysis cleft and cyclitic membrane. It may fail to demonstrate incarceration of an implant, however. Proper surgical technique may prevent this complication.

Original languageEnglish (US)
Pages (from-to)137-139
Number of pages3
JournalRetinal Cases and Brief Reports
Volume4
Issue number2
DOIs
StatePublished - Mar 2010

Fingerprint

Fluocinolone Acetonide
Acoustic Microscopy
Cryotherapy
Vitrectomy
Uveitis
Intraocular Pressure
Cyclosporine
Visual Acuity
Triamcinolone Acetonide
Temazepam
Membranes
Aqueous Humor
Ambulatory Surgical Procedures
Fingers
Pathology
Injections
Wounds and Injuries

Keywords

  • Choroidal detachment
  • Fluocinolone acetonide
  • Fluocinolone acetonide implant
  • Hypotony
  • Incarceration
  • Posterior uveal cleft
  • Retisert
  • Ultrasound biomicroscopy
  • Uveitis

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Posterior uveal cleft and hypotony complicating insertion of a fluocinolone acetonide implant. / Pasadhika, Sirichai; Smith, Justine R.; Flaxel, Christina.

In: Retinal Cases and Brief Reports, Vol. 4, No. 2, 03.2010, p. 137-139.

Research output: Contribution to journalArticle

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abstract = "Purpose: To describe posterior uveal cleft and chronic hypotony occurring in association with a fluocinolone acetonide implant (Retisert) that was successfully treated by vitrectomy, removal of the implant, and cryotherapy. Methods: A 57-year-old female patient with idiopathic uveitis, well-controlled with cyclosporine, developed chronic hypotony with maculopathy after insertion of a fluocinolone acetonide implant. Visual acuity in the affected eye was counting fingers, and intraocular pressure was 0 mmHg. Wound leakage, cyclodialysis cleft, and cyclitic membrane were excluded. Ultrasound biomicroscopy demonstrated a posterior uveal cleft at the site of implant, which was presumed to have created a channel for passage of intraocular fluid to the suprachoroidal space. The patient was treated with pars plana vitrectomy, removal of the implant, cryotherapy at the implant site, and intravitreal triamcinolone acetonide injection. Results: The procedure was well tolerated. Intraoperative appearance suggested incarceration of the implant, which did not show on ultrasound biomicroscopy. Intraocular pressure was normalized 5 days after the surgery. Postoperative visual acuity improved to 20/200 at 2 weeks after the surgery and remained stable through 1 year of follow-up. Uveitis remains well controlled with cyclosporine at 1 year after the procedure. Conclusion: Posterior uveal cleft may cause hypotony as a complication of insertion of a fluocinolone acetonide implant. The ultrasound biomicroscopy is a crucial investigation to establish the diagnosis and to exclude other pathologies including cyclodialysis cleft and cyclitic membrane. It may fail to demonstrate incarceration of an implant, however. Proper surgical technique may prevent this complication.",
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