resge in ight - Kresge Eye Institute

New Use of Retisert Implant Allows Combined Cataract, Glaucoma SurgeryWhen Ella* first came toDMC Kresge Eye Instituteher vision was limited tovisualizing hand motionOD and 20/80 OS dueto granulomatous uveiticglaucoma. The patient’s longterminflammation had causedadvanced glaucoma andcataracts. Despite an Ahmedvalve placement and medicalmanagement with high doses of oral prednisone for two years, the 50-yearoldpatient’s vision did not improve.Now, following an innovative surgical procedure by retinal specialist Tamer Mahmoud,M.D., Ph.D., the patient is back to work after years on disability and reports vision of20/30 OD and 20/25 OS one year post-operatively.Dr. Mahmoud, an assistant professor of ophthalmology at Wayne State UniversitySchool of Medicine and a retinal specialist on staff at DMC Kresge Eye Institute,recognized that performing the lensectomy and vitrectomy that the patient neededwould be complicated, given the active, long-term inflammation. High doses ofsteroid would be needed, which the patient was not tolerating well. The procedures aretraditionally done successively in eyes with advanced disease.Dr. Mahmoud decided to combine acataract extraction and intraocular lensimplant, a vitrectomy, a repositioning ofthe Ahmed tube and Retisert implant in asingle procedure.“As an academic eye center we wereable to bring in an advanced teamof subspecialist surgeons – cataract,glaucoma and myself as the retinasurgeon – to perform this combinedprocedure on each eye successively,” Dr.Mahmoud says. “The Retisert implantallows a more aggressive surgical approachand has expanded treatment options forpatients.”Following the procedure, Ella was ableto stop oral prednisone and glaucoma eye drops and has had remarkable functionaloutcomes.“Despite years of inflammation, she regained vision, which was unexpected,”comments Dr. Mahmoud. “Previously, we would have expected permanent vision lossin this type of case and told the patient there was nothing we could do. This procedureis giving a whole group of patients hope for treatment.”Since FDA approval three years ago, the use of a fluocinolone intravitreal implant(Retisert®) has been used to treat chronic noninfectious posterior uveitis and had beenimplanted in combination with glaucoma procedures. “The advantage of Retisert is thedelivery of steroid directly to the eye, avoiding systemic complications,”Dr. Mahmoud says.Ella’s case has been presented for publication and Dr. Mahmoud has since performedsimilar procedures in additional patients.*Not patient’s real name