Outcomes of Birdshot Chorioretinopathy Treated With an Intravitreal Sustained-Release Fluocinolone Acetonide–Containing Device

PurposeTo evaluate outcomes in birdshot chorioretinopathy following intravitreal implantation of a fluocinolone acetonide–containing drug delivery device.DesignRetrospective, multicenter, interventional case study.MethodsUniversity- and community-based tertiary care. Twenty-two HLA-A29+ birdshot patients (36 eyes) were implanted with a sustained-release corticosteroid device and followed for up to 3 years. Main outcome measures were Snellen acuity, intraocular inflammation, adjunctive therapy, cataract, ocular hypertension, or glaucoma. Paired Wilcoxon statistics were used to analyze visual acuities; paired McNemar statistics were used to analyze presence or absence of other outcomes.ResultsNineteen of 22 patients (32 eyes) completed 12 months of follow-up with improvement in median visual acuity (P = .015). Prior to implantation, 18 of 22 patients (82%) received immunosuppressive therapy versus 1 of 19 (5%) by 12 months (P < .001). Eyes with zero vitreous haze increased from 7 of 27 scored eyes (26%) at baseline to 30 of 30 eyes (100%) by 12 months (P < .001). Cystoid macular edema decreased from 13 of 36 eyes (36%) at baseline to 2 of 32 eyes (6%) at 12 months (P = .006). Five of 24 phakic eyes at baseline exited the study before surgery; all other eyes received cataract surgery. One hundred percent of study eyes had ocular hypertension, required intraocular pressure–lowering therapy, or had glaucoma surgery by 12 months.ConclusionsImplantation of a fluocinolone acetonide–containing intraocular device in birdshot chorioretinopathy can improve vision, control inflammation, and eliminate systemic therapy. There is a high incidence of cataract progression and intraocular hypertension or glaucoma.