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Tiny Implant Provides Relief to Patients with Severe Uveitis

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Duke Health News 919-660-1306

Durham, 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 -- blindness.

"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 in which 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 problem.

"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.

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 of treating severe uveitis may be different than
those for treating eye diseases like glaucoma or macular
degeneration, he added.

"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."

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. The implant procedure is
performed under local anesthesia, where it is attached inside
the eye with a suture. 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 to me."

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