Scleral Fixation of the Fluocinolone Acetonide Implant in Eyes with Severe Iris–Lens Diaphragm Disruption and Recalcitrant CME: The Fluocinolone-Loop-Anchoring Technique (FLAT)

Abstract

Introduction

While proven to be an effective treatment for cystoid macular edema (CME) and diabetic macular edema, intravitreal steroid implants (IVSI) may cause undesirable side effects, including steroid-related glaucoma or migration into the anterior chamber in the case of iris–lens diaphragm disruption. Here we present a new surgical technique that allows for the easy implantation and subsequent fixation of the fluocinolone acetonide intravitreal implant without the risk of migration as a feasible and possibly reversible approach in the treatment of persistent CME in severely damaged eyes.

Methods

In this single-center, prospective off-label, proof of principle, scleral fixation of the fluocinolone implant was performed in two eyes with disrupted anterior–posterior segment border and persistent CME. Both eyes were then followed monthly in accordance to a detailed protocol.

Results

The procedure was overall well tolerated without severe side effects. There was no migration of the implant in the anterior chamber in either eye.

Conclusion

Scleral fixation of the fluocinolone implant proved to be a safe and feasible approach in eyes with persistent CME and disrupted anterior–posterior segment border. This new technique also allows for the possible removal of the implant and may therefore be suitable even for eyes at higher risk for side effects, such as glaucoma.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Cunha-Vaz J, Ashton P, Iezzi R, et al. Sustained delivery fluocinolone acetonide vitreous implants: long-term benefit in patients with chronic diabetic macular edema. Ophthalmology. 2014;121(10):1892–903.

  2. 2.

    Mayer WJ, Kurz S, Wolf A, et al. Dexamethasone implant as an effective treatment option for macular edema due to Irvine–Gass syndrome. J Cataract Refract Surg. 2015;41(9):1954–61.

    Article  Google Scholar 

  3. 3.

    Rahimy E, Khurana RN. Anterior segment migration of dexamethasone implant: risk factors, complications, and management. Curr Opin Ophthalmol. 2017;28(3):246–51.

    Article  Google Scholar 

  4. 4.

    Papastavrou VT, Zambarakji H, Dooley I, et al. Observation: fluocinolone acetonide (Iluvien) implant migration in to the anterior chamber. Retin Cases Brief Rep. 2017;11(1):44–6.

    Article  Google Scholar 

  5. 5.

    Mateo C, Alkabes M, Burés-Jelstrup A. Scleral fixation of dexamethasone intravitreal implant (OZURDEX®) in a case of angle-supported lens implantation. Int Ophthalmol. 2014;34(3):661–5.

    Article  Google Scholar 

Download references

Acknowledgements

Funding

No funding or sponsorship was received for this study, or publication of this article. The Rapid Service Fee was funded by the authors themselves.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authorship Contributions

We are grateful to Felicitas Cinkler for her technical assistance and support.

Prior Presentation

This study was partly presented at the DOC Congress 2018, Nürnberg, Germany, the Floretina Congress 2019, Florence, Italy and at the DOG Congress 2019, Berlin, Germany.

Disclosures

Tina R Herold: Novartis Pharma, Allergan Pharm, Bayer (honoraria). Raffael Liegl: Novartis (honoraria). Siegfried G Priglinger: Novartis Pharma GmbH (advisory boards/honoraria), Pharm Allergan (advisory board/honoraria), Zeiss (advisory boards/honoraria), Bayer (honoraria), Alcon (honoraria), Oxurion (honoraria) and Rayner (honoraria). Armin Wolf: Novartis Pharma GmbH, Bayer, Alimera, Allergan, Oertli (travel cost, honoraria, consulting), Roche and Appellis (ongoing clinical trials). Susanna Koenig and Ahmed Almarzoogi have nothing to delcare.

Compliance with Ethics Guidelines

For this single-center, prospective off-label proof of principle of a new surgical technique, no ethics committee approval was required. The study was however performed in accordance with the Helsinki Declaration of 1964 and its later amendments. The included patients signed written informed consent for this off-label surgical procedure and off-label use of the fluocinolone implant and provided consent to publication of their anonymized data and images.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Tina R. Herold.

Additional information

Enhanced digital features

To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare.11673996.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Herold, T.R., Liegl, R., Koenig, S. et al. Scleral Fixation of the Fluocinolone Acetonide Implant in Eyes with Severe Iris–Lens Diaphragm Disruption and Recalcitrant CME: The Fluocinolone-Loop-Anchoring Technique (FLAT). Ophthalmol Ther 9, 175–179 (2020). https://doi.org/10.1007/s40123-020-00232-2

Download citation

Keywords

  • Cystoid macular edema
  • Fluocinolone implant
  • Iris–lens diaphragm disruption
  • Scleral fixation