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 offlabel, 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.

Off-Label Use of 0.19 mg Fluocinolone Acetonide Intravitreal Implant: A Systematic Review

“…e eligibility was accessed in 19 studies, and a total of 11 were included in this review. Of these 11 studies, 6 are case reports [20][21][22][23][24][25], 1 is a case series [26], 1 is an abstract [27], 1 is a retrospective study [28], and 2 are randomized control trials [29,30]. e main characteristics of the included studies are presented in Table 1.…”

“…Herold et al [ 25 ] reported two patients with disrupted anterior-posterior segment border and persistent CME. Both patients (1 eye each) were treated with a DEX implant, and both patients experienced problems related to the implant or migration of the implant into the anterior chamber.…”

“…Herold et al [ 25 ] developed a technique named Fluocinolone Loop-Anchoring Technique (FLAT) with the goal to eliminate the risk of anterior migration of the implant in severely damaged eyes.…”

“…Although being uncommon, it has a higher probability of occurring when the patient has a disrupted anterior-posterior segment border after complicated cataract surgery [ 10 , 39 ]. Herold et al [ 25 ] developed FLAT to treat two patients with disrupted anterior-posterior segment border with persistent CME. The procedure was well tolerated by the patients and just some discomfort in the suture area was documented.…”

Long-Term Efficacy of Fluocinolone in Eyes With Iris–lens Diaphragm Disruption and Pcme With Medication Fixed in the Sclera (Mefisto)

“…The surgical procedure of scleral fixation of the fluocinolone acetonide implant (Iluvien, Alimera Sciences Inc, Alpharetta, GA) was performed under local anesthesia with retrobulbar injection of lidocaine or sub-tenon anesthesia according to the protocol of the FLAT-technique that has been described before. 10 …”