June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
The use of fluocinolone acetonide implant(ILUVIEN) in patients with diabetic macular edema(DME) previously treated with dexamethasone intravitreal implant(OZURDEX) – Efficacy and safety outcomes from clinical practice in Glasgow,Scotland
Author Affiliations & Notes
  • Sridevi Rajasekaran
    Ophthalmology, New Victoria Hospital, Glasgow, West of Scotland, United Kingdom
  • Umaima Mulla
    Ophthalmology, New Victoria Hospital, Glasgow, West of Scotland, United Kingdom
  • Suzannah Drummond
    Ophthalmology, Glasgow Royal Infirmary, Glasgow, United Kingdom
  • Mike Gavin
    Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom
  • William Wykes
    Ophthalmology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
  • Footnotes
    Commercial Relationships   Sridevi Rajasekaran, None; Umaima Mulla, None; Suzannah Drummond, Alimera Sciences (S); Mike Gavin, Alimera Sciences (S), Allergan (S), Bayer (S); William Wykes, Alimera Sciences (S), Allergan (S)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 1909. doi:
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      Sridevi Rajasekaran, Umaima Mulla, Suzannah Drummond, Mike Gavin, William Wykes; The use of fluocinolone acetonide implant(ILUVIEN) in patients with diabetic macular edema(DME) previously treated with dexamethasone intravitreal implant(OZURDEX) – Efficacy and safety outcomes from clinical practice in Glasgow,Scotland. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1909.

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

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Abstract

Purpose : In contrast to the FAME studies,where diabetic macular edema(DME) patients had only been previously treated with laser photocoagulation, patients being treated with fluocinolone acetonide implant(ILUVIEN) in routine clinical practice are exposed to a wide spectrum of DME therapies,including anti-VEGF agents and short-acting corticosteroids.This case series focuses on patients’ response to fluocinolone acetonide implant after prior treatment with dexamethasone implant(OZURDEX).

Methods : A retrospective observational case review from a single Scottish Health Board,involving 10 patients and 13 eyes(7 patients treated unilaterally and 3 treated bilaterally)with DME treated with a single fluocinolone acetonide implant per eye from July 2015 onwards.In these patients,
efficacy(visual acuity[VA] and central macular thickness[CMT]) and safety parameters(intraocular pressure [IOP]) were measured to assess the clinical benefit of fluocinolone acetonide treatment.Values are plotted as mean±SEM.

Results : The mean age of the patients was 68 years,61.5% were female and the duration of DME ranged between 2 and 12 years.2 eyes were phakic (one requiring cataract removal after fluocinolone acetonide therapy),11 eyes were pseudophakic and 2 patients had previous vitrectomy.At baseline,the mean VA was 37.1±5.4 letters,the mean CMT was 463.1±45.2 µm and the mean IOP was 16.8±0.8 mmHg.Patients had been treated with a mean of 5.5(range 0 to 11) injections of anti-VEGF agents,and 1.9 (range,1 to 3) injections of dexamethasone prior to intravitreal injection of fluocinolone acetonide.At last observation,mean VA increased by 17.1±4.5 letters(p=0.0026),CMT decreased by 139.4±47µm (p=0.0135) and mean IOP increased by 1.46±0.99 mmHg(p=0.166).The mean VA peaked at 3 months post-fluocinolone acetonide(55.0±5.9 letters) and remained relatively stable through to month 12(Figure1),whilst the mean decrease in CMT was apparent within the first month of treatment(304.1±54.2µm) and sustained up to 12 months(Figure2).

Conclusions : Despite a long duration of DME and prior treatments with anti-VEGF and multiple dexamethasone implants,the eyes in this study showed a rapid reduction in edema and significant gain in vision,sustained throughout 12 months,with minimal change in intraocular pressure.

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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