OSLI Retina

May 2019

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266 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina Editorial ABSTRACT: The authors pro- vide a significant interpreta- tion of the National Eye In- stitute-sponsored Multicenter Uveitis Steroid Treatment study, in which patients with severe, non-infectious inter- mediate, posterior, or panuve- itis were randomly assigned to receive local treatment us- ing the sutured intravitreal fluocinolone acetonide im- plant or systemic treatment consisting of oral steroids and conventional steroid-sparing immunosuppression, with a primary outcome of visual acuity at 2 years of follow-up. The authors also present evi- dence-based guidance for the treatment of noninfectious posterior segment involving uveitis. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:266-268.] MUST Beg to Differ Thomas Albini, MD; Natalia F. Callaway, MD, MS; Glenn J. Jaffe, MD; William Feuer, MS; Janet Davis, MD; Debra Goldstein, MD; Careen Lowder, MD; Phoebe Lin, MD, PhD; Quan Nguyen, MD; Sunil Srivastava, MD; David Callanan, MD; Anat Galor, MD; Raquel Goldhardt, MD; Harry Flynn Jr., MD In the National Eye Institute-sponsored Multicenter Uveitis Steroid Treat- ment (MUST) study, patients with severe, non-infectious intermediate, poste- rior, or panuveitis were randomized to receive local treatment, using the sutured intravitreal fluocinolone acetonide implant (Retisert; Bausch + Lomb, Rochester, NY), or systemic treatment, consisting of oral steroids and conventional steroid- sparing immunosuppression. The primary outcome was visual acuity (VA) at 2 years of follow-up. The study group continued to follow enrolled subjects for a total of 7 years. 1-3 The published 7-year follow-up study concluded that systemic treatment was superior in efficacy and safety compared to the implant. How- ever, there remain some significant considerations that weaken this conclusion and support the continued use of the implant in many patients. Although the study suggests that the implant be used as a second-line treatment, there is a substantial case to be made that, given the available data, the implant is still a reasonable option for first-line therapy. Individual patient features and circum- stances may make the implant a better choice, such as potential side-effects of systemic therapy, patient desire for pregnancy, patient prejudice against sys- temic therapy, and the complexity and number of systemic agents required to control a particular patient's ocular inflammation. The sutured fluocinolone implant was U.S. Food and Drug Administration- approved for the treatment of non-infectious intermediate, posterior, and panu- veitis in 2005. It was designed to release a steady concentration of fluocinolone From Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami (TA, NFC, WF, JD, AG, RG, HFJ); the Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina (GJJ); the Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago (DG); Cole Eye Institute, Cleveland Clinic, Cleveland (CL, SS); Casey Eye Institute, Oregon Health and Science University, Portland, Oregon (PL); Byers Eye Institute, Stanford University, Palo Alto, California (QN); and Texas Retina Associates, Dallas (DC). Originally submitted July 8, 2018. Revision received March 27, 2019. Accepted for publication March 27, 2019. Supported in part by an unrestricted grant to the Bascom Palmer Eye Institute/Department of Ophthal- mology University of Miami from Research to Prevent Blindness, New York, and by grants from the National Institutes of Health (NIH) (Center Core grant, P30EY014801, P30EY001319, and R01EY026174), the Depart- ment of Defense (W81XWH-09-1-0675), the Department of Veterans Affairs, Veterans Health Administra- tion, Office of Research and Development, Clinical Sciences Research EPID-006-15S (AG), and the Klorfine Foundation (TA). Dr. Albini has received personal fees from Bausch + Lomb and EyePoint outside the submitted work. Dr. Jaffe has received personal fees from AbbVie outside the submitted work. Dr. Feuer received a grant from the NIH (Core Center Grant P30-EY014801) and an unrestricted grant from Research to Prevent Blindness during the conduct of this study. Dr. Davis is a consultant for AbbVie. Dr. Lin is on the advisory board for Mallinckrodt and Clearside outside the submitted work. Dr. Nguyen has received grants from and is on the scientific advisory board for Bausch + Lomb outside the submitted work. Dr. Srivastava has received grants and personal fees from Bausch + Lomb, Santen, Psivida, Allergan, and Novartis, and personal fees from Regeneron, Zeiss, and Optos outside the submitted work. Dr. Callanan is a consultant for AbbVie, Allergan, EyePoint, Eyevensys, Graybug, Regeneron, and Santen. The remaining authors report no relevant financial disclosures. The authors would like to acknowledge John Kempen, MD, MPH, PhD, MHS, international vice-chair of the Multicenter Uveitis Steroid Treatment (MUST) trial, for his critical review of this manuscript. Address correspondence to Thomas Albini, MD, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136; email: talbini@med.miami.edu. doi: 10.3928/23258160-20190503-01

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