June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Selective laser trabeculoplasty (SLT) for the reduction of elevated intraocular pressure (IOP) associated with fluocinolone acetonide (FAc) intravitreal implants
Author Affiliations & Notes
  • Nathan M Radcliffe
    New York University, New York, New York, United States
  • Footnotes
    Commercial Relationships   Nathan Radcliffe, Aerie Pharmaceuticals (C), Alcon Laboratories (C), Alimera (P), Allergan (C), Bausch + Lomb (C), Beaver-Visitec International (C), Iridex (C), Lumenis (C), New World Medical (C), Reichert (C), Transcend Medical (C)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 917. doi:
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    • Get Citation

      Nathan M Radcliffe; Selective laser trabeculoplasty (SLT) for the reduction of elevated intraocular pressure (IOP) associated with fluocinolone acetonide (FAc) intravitreal implants. Invest. Ophthalmol. Vis. Sci. 2017;58(8):917.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Elevated IOP is a common adverse event of intravitreal steroid treatment. First-line management of elevated IOP is topical IOP-lowering eye drops, but this is not always successful. The purpose of this analysis is to determine the efficacy of SLT for the reduction of IOP and IOP-lowering medications in patients treated with the low-dose, long-acting intravitreal FAc implant (ILUVIEN®).

Methods : The FAME trials were randomized, double-masked, parallel group studies analyzing the safety and efficacy of two dosages of the FAc implant. Patients with DME and IOP≤21 mmHg, who were not receiving IOP-lowering medication, were included in the studies and received either 0.2 µg/day or 0.5 µg/day FAc implant, or sham control for up to 36 months. Increases in IOP (>30 mmHg) were treated initially with IOP-lowering medication, and at the investigator’s discretion, by SLT or incisional surgery if the patient failed to respond to medication. Patients were assessed for changes in use of IOP-lowering medication, IOP and for incisional glaucoma surgery.

Results : Of the patients who received FAc implants, 43.1% (331/768) required IOP-lowering medication, compared with 14.1% (26/185) in the sham control group. Only 1.8% (14/768) FAc-treated patients received SLT to treat elevated IOP, compared with 6.5% (50/768) who received incisional surgery (Table).
A reduction in IOP was observed in 9/14 SLT-treated patients, where there was no need to proceed to IOP-lowering surgery. In these patients, mean IOP was reduced by 50% (pre- and post-SLT IOP of 35.9 and 16.4 mmHg, respectively). In conjunction with this, there was a reduction in the mean number of IOP lowering medications by 20%; mean numbers were 2.3 medications pre- and 1.8 medications post-SLT.

Conclusions : In this cohort of patients exposed to a continuous, microdose, long-acting intravitreal FAc implant, who underwent SLT for IOP reduction, success was achieved in reducing IOP while reducing the mean number of IOP-lowering medications. Despite the success of SLT in lowering IOP, it was the least-used IOP-lowering intervention, suggesting there is potentially a greater role for SLT as a less-invasive treatment for the management of IOP elevation associated with FAc, to reduce the requirement for incisional surgery.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

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