implant provides relief to patients with severe uveitis
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[JAN. 26, 2006]
N.C. -- Greater relief may be available for patients with severe
uveitis, thanks to a tiny implant that's not much larger than a
grain of rice. The implant, called Retisert, contains a tiny pellet
of steroidal medication that, once placed in the eye, slowly
delivers a powerful medication over a long period of time --
providing patients with relief for their condition and saving them
both time and the side effects found with other therapies.
Patients with severe
uveitis, an inflammatory eye disease, often experience pain,
sensitivity to light, visual impairment and -- in the worst cases --
"The implant makes a big difference in treatment because it
allows us to give a very small, targeted dose of the medication
directly where it needs to go, which is inside the eye," said Glenn
Jaffe, M.D., an ophthalmologist and director of the uveitis program
at Duke University Eye Center.
"We no longer have to give a person large doses of medicine, which
basically treat the entire body, in order to reach the eye."
The inflammatory disease is similar to arthritis, according to
Jaffe, who led several clinical trials of Retisert. The medication
in the implant is released slowly over a period of two to three
years and works to alleviate inflammation. This time-released
medication is expected to save the patient from having to take
multiple doses of medication throughout the day and from enduring
various shots of drugs directly to their eye area during times when
the disease flares up.
"The whole idea of developing the implant is to provide a
consistent delivery of medication that can quiet down the
inflammation within the eye without causing side effects elsewhere
in the body," said Jaffe. "We can potentially then get people off
all the other medications they have needed for years, many of which
cause significant side effects and are uncomfortable, making the
patient fairly miserable."
Although not particularly common, the disease typically strikes
people during their most productive years – between their 20s and
40s. Experts estimate that approximately 175,000 Americans have been
diagnosed and roughly 800,000 people worldwide are living with the
"For patients with the disease, it is very common for them to
experience redness and pain in the eye, and bright lights can be
bothersome," said Jaffe. "When uveitis occurs in the rear of the
eye, as with the posterior form, it can cause visual impairments.
This is particularly true when the inflammation is affecting the
retina or the macula."
According to Jaffe, the posterior form of the disease can lead to
macular edema, growth of abnormal blood vessels, the development of
scar tissue, and occasionally a patient can experience blocked blood
vessels in the retina, all of which are problems for the patient.
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Effective treatments have been available, but they have
significant side effects, Jaffe said. During periods of severe
inflammation, patients sometimes need to take their medication every
hour for about a week and then taper down for a period of several
weeks until the inflammation has subsided. When that doesn't work,
Jaffe points out, patients sometimes need to receive steroid
injections around the eye, oftentimes along with oral medications.
Although use of the implant can eliminate the side effects caused
by other medications, the Retisert may lead to the development of
cataracts or increased intraocular pressure. But, Jaffe noted, those
side effects can be managed effectively.
The goals in treating severe uveitis may be different from those
for treating eye diseases like glaucoma or macular degeneration, he
"Preventing uveitis from getting worse is clearly one of the
goals for treatment, but another goal is to keep their eye
comfortable," Jaffe said. "In some cases this pain can be disabling,
and the loss of vision can, not infrequently, be pretty profound.
The goal of the treatment is to control the inflammation. If we can
control the inflammation, the patient is more comfortable, and we
have a much better chance of preserving or improving their vision."
Under local anesthesia, the implant is attached inside the eye
with a suture. The implant itself is made of a material similar to
what is used to create intraocular lens implants, and it does not
dissolve along with the drug. Once the medication dissolves, the
casing remains behind, but that doesn't pose a problem, said Jaffe.
"The ability to provide this new treatment option has really
changed my uveitis clinic," he added. "We've gone from having a lot
of unhappy people with chronic disease who didn't feel they had a
lot of hope, to a clinic that is fun to go to because people are
feeling really good for a change. And that's a big deal to them and
[Duke University news release]