Long-term outcomes of intravitreal 0.19 mg fluocinolone acetonide implant in uveitic macular edema after prior local corticosteroid treatments

This study evaluates the long-term efficacy and safety of intravitreal 0.19 mg fluocinolone acetonide implant (FAi) in non-infectious UME, comparing it with prior sub-Tenon’s triamcinolone acetonide (STTA) and/or intravitreal dexamethasone implant (DEXAi). A retrospective review of patients with chronic non-infectious UME who received intravitreal FAi after STTA and/or DEXAi. Thirteen eyes from 7 patients (69.2% female) were included, with a mean age of 65 ± 11 years. The median follow-up was 54 months before FAi (IQR: 43–65) and 47 months after FAi (IQR: 23–60). All eyes received at least one STTA, and 11 eyes received at least one DEXAi before FAi. The median number of injections before FAi was 4 (range: 2–8). A significant reduction in recurrences per year was observed after FAi (4.62 ± 1.9 before vs. 0.31 ± 0.5 after, Wilcoxon test, p = 0.001). Macular edema relapsed in 4 eyes (30.8%) between months 28 and 36. Central retinal thickness significantly decreased after FAi (474 ± 96 μm before vs. 305 ± 58 μm after, Wilcoxon test, p = 0.002). Ten eyes (76.9%) showed BCVA improvement (1–4 lines), and none lost visual acuity. All eyes were pseudophakic prior to FAi. At FAi, four of seven patients were on systemic anti-inflammatory therapy; 3 discontinued it, and none started new treatment after FAi. Five eyes were on topical IOP-lowering medication at the time of FAi; 2 required and increase in treatment, and 2 later underwent trabeculectomy. After FAi, only two eyes started IOP-lowering medication. In this case series with long-term follow-up, FAi for non-infectious UME was effective, safe, and reduced recurrences compared to other local corticosteroids.