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Shaina M Rubino, Chris Bligh Komanski, Vishak J John; Treatment of Refractory Diabetic Macular Edema with Intravitreal Injection of a Fluocinolone Acetonide Implant. Invest. Ophthalmol. Vis. Sci. 2017;58(8):912.
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© ARVO (1962-2015); The Authors (2016-present)
Management of patients with diabetic macular edema is complex. Patients who fail initial treatment challenge providers to consider alternative therapies when data remains scarce and new therapies are emerging. This retrospective study focuses on patients who were initially treated with VEGF inhibitors, failed treatment, and were subsequently treated with an intravitreal injection of a fluocinolone acetonide implant (FAc), a long-acting steroid. We hypothesize that patients who fail therapy with VEGF inhibitors and are treated with FAc often require rescue therapy, but have a significant reduction in treatment burden.
This retrospective study included 16 eyes with diabetic macular edema that failed treatment with a VEGF inhibitor and subsequently received FAc. All patients had a complete eye exam and macular optical coherence tomography (OCT) at baseline as well as repeat assessments at follow-up visits. All patients were followed and treated for at least 1 year prior to injection with FAc. Primary end points included injection events, OCT analysis, and visual acuity. Secondary end points included intraocular pressure, lens status, and other side effects.
Data prior to FAc injection was compared with data following injection. Average follow-up post-injection is 146 days at this time. There was no significant difference in LogMAR visual acuity (p=0.25). Central foveal thickness decreased from 389 to 353um (p=0.03). Intraocular pressure increased from 15.8 to 17.8 mmHg (p<0.005). The average interval between anti-VEGF injections increased from 52 to 217 days (p=0.005). The number of anti-VEGF injections per 28-day period decreased from 0.376 to 0.088 injections (P<0.005, Figure 1). Current data is limited by incomplete follow up, and data collection is ongoing.
FAc decreases the treatment burden although patients may require adjuvant therapy. We hope that this study will help inform physician and patient expectations. Future data collection may help predict which patients are more likely to require rescue therapy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Figure 1. Effect of FAc on Frequency of Anti-VEGF injection.
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