resge in ight - Kresge Eye Institute

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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
C ataract Patient Shares Experience in VideoBetty Allen has worked at the John D. Dingell VA Medical Center on the DMC campus for 31 years as an MRI and CT technician,so she knew how to handle rush hour traffic. So when she started staying at work late to avoid driving in traffic, she knew she had aproblem with her eyesight.“If I had to read a street sign I would park the car, get out and walk up to it,” Allen, 64, recalls.“Glare or rain made the letters run together.”Cataracts were clouding her vision so that she also had difficultyseeing a computer screen at work.She finally went to see Anju Goyal, M.D., a cataract and glaucomaspecialist at DMC Kresge Eye Institute. In April 2008,Dr. Goyal performed a cataract extraction with intraocularlens implant in Allen’s right eye. In September, Allen wentback for her second surgery.“I could hardly wait forthe second surgery.”“I could hardly wait for the second surgery,” she says. “Forboth surgeries, I had the procedure on a Tuesday and was backat work on Friday. I could have gone back sooner, because Ifelt great.”“Dr. Goyal was very thorough and explained what she wasdoing. Everyone at Kresge was very nice and helpful.”Allen was so pleased with the outcome at Kresge that sheagreed to be featured in a video that is currently available inthe medical library on www.dmc.org.www.dmc.org
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