Sympathetic ophthalmia is an autoimmune condition thought to be caused when one’s eye is severely damaged, and the immune system overreacts and attacks the healthy eye, often leading to complete blindness. Previously, doctors had to use whole-body drugs with serious side effects to "shut down" a person's entire immune system to stop the attack on the eye. However, ophthalmologists at the University of Iowa have tested and are now using a surgical implant called Retisert, from Bausch & Lomb, to prevent complete vision loss and eliminate dependence on systemic, or whole-body, immunosuppression.

"Until recently, the primary treatment option for sympathetic ophthalmia was nonsurgical and involved high doses of oral steroids followed by oral immunosuppressive medication to preserve vision in a patient's remaining eye," said Vinit Mahajan, M.D., Ph.D., assistant professor of ophthalmology and visual sciences at the UI Roy J. and Lucille A. Carver from the College of Medicine, and a retinal surgeon with UI Hospitals and Clinics.

 

"But this treatment, similar to organ transplantation cases, subjects patients to life-long use of immunosuppressive drugs that have serious side effects such as osteoporosis, weight gain, potentially life-threatening infection and liver or kidney damage," he added.

 

What the new Retisert treatment involves is the surgical implantation into the endangered eye of a small plastic tab that contains a slow-release steroid, called fluocinoloe acetonide. The insert provides immunosuppression only to the endangered eye, not other body parts. It lasts for about two-and-a-half years and then can be replaced.

 

While each implant costs approximately $20,000, their use appears to be less expensive over the long run compared to systemic immunosuppressive drugs and the required frequent hospital visits. "If you add up the total number of patient visits, costs of lab tests and the costs of the immunosuppressive drugs, the $20,000 for the device is cheaper," Mahajan said.

 

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