Name of the Procedure:

Injection, Fluocinolone Acetonide, Intravitreal Implant (Retisert), 0.01 mg (J7311)

Common Names: Retisert, Intravitreal Implant for Macular Edema

Medical Term: Intravitreal Fluocinolone Acetonide Implant Injection

Summary

This procedure involves the placement of a tiny implant into the eye that slowly releases a medication called fluocinolone acetonide to treat certain eye conditions. The implant is inserted through a small injection into the vitreous humor, the eye’s gel-like interior.

Purpose

Medical Conditions Addressed:

• Chronic non-infectious uveitis affecting the posterior segment of the eye
• Macular edema

Goals:

• Reduce inflammation within the eye
• Decrease swelling in the macula
• Preserve or improve vision

Indications

Symptoms/Conditions:

• Persistent vision loss due to macular edema
• Chronic uveitis that hasn’t responded to other treatments

Patient Criteria:

• Adults with a diagnosis of non-infectious posterior uveitis
• Patients who are not responding adequately to corticosteroid eye drops or other systemic treatments

Preparation

Pre-Procedure Instructions:

• Arrive with a driver or arrange for transportation post-procedure
• Avoid wearing eye makeup
• Follow any specific instructions provided by the ophthalmologist, which may include fasting or adjusting certain medications

Diagnostic Tests/Assessments:

• Comprehensive eye examination
• Possible imaging tests (e.g., Optical Coherence Tomography) to assess the macula’s condition

Procedure Description

1. Anesthesia: Local anesthesia administered via eye drops or an injection around the eye to ensure the procedure is painless.
2. Preparation: The eye and surrounding area are cleaned and sterilized.
3. Implantation: The ophthalmologist uses a small needle to inject the Retisert implant into the vitreous humor.
4. Verification: The position of the implant is confirmed, usually with an eye examination or imaging technique.

Tools/Equipment:

• Sterile needles
• Retisert implant
• Local anesthetics

Duration

The entire procedure typically takes about 15 to 30 minutes.

Setting

The procedure is generally performed in an outpatient clinic or a specialized office equipped with the necessary ophthalmological tools.

Personnel

• Ophthalmologist (eye surgeon)
• Ophthalmic nurse or assistant

Risks and Complications

Common Risks:

• Increased intraocular pressure
• Eye pain
• Redness or swelling

Rare Risks:

• Infection inside the eye (endophthalmitis)
• Retinal detachment
• Cataract formation

Management:

Any complications are usually manageable with medication or additional procedures.

Benefits

Expected Benefits:

• Reduction in eye inflammation and macular swelling
• Potential improvement in vision ##### Timeline: Benefits may be noticed within a few weeks, with full effects typically developing over several months.

Recovery

Post-Procedure Care:

• Use prescribed eye drops to prevent infection or manage inflammation
• Avoid rubbing or pressing on the eye
• Attend follow-up appointments for monitoring intraocular pressure and implant position

Recovery Time:

Most patients can resume normal activities within a day or two, though complete recovery and the realization of full benefits can take a few months.

Alternatives

Other Treatment Options:

• Systemic corticosteroids
• Other intravitreal injections (e.g., anti-VEGF injections)
• Immunosuppressive drug therapy
• Vitrectomy surgery

Pros and Cons:

• Alternative treatments may have varying degrees of efficacy and risk profiles, and the choice between them depends on the patient’s overall health, the severity of the condition, and response to previous treatments.

Patient Experience

During Procedure:

• Minimal discomfort due to local anesthesia
• Sensation of pressure but not pain

After Procedure:

• Mild discomfort or irritation in the eye for a few days
• Vision may be blurry initially but should stabilize quickly
• Pain management using over-the-counter pain relievers and prescribed eye drops

Comfort Measures:

• Use of protective eye shields as instructed
• Keeping the eye clean and avoiding strenuous activity