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Carlos Marques-Neves, João Paulo Castro e Sousa, David Martins, António Sampaio, Paulo Kaku; Switching corticosteroids therapy for diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2017;58(8):100.
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Intraocular corticosteroids have been shown to be a promising strategy for macular edema due to vascular diseases. There are several implants available, although in patients with chronic edema marked by recurrences, it is desirable to have a longer treatment duration. The aim of this study is to report visual and anatomic outcomes of patients with diabetic macular edema (DME) who switched from dexamethasone (Dex) to fluocinolone acetonide (FAc) intravitreal implant.
5 centers retrospective review case series of patients with DME who previously received Dex and were followed-up for 6 months. 23 eyes of 20 patients were included in this analysis, 73.9% male, 26.1% female, mean age of 68.1 years and mean duration of DME of 4.8 years. Outcomes were analyzed at 1, 3 and 6 months after FAc and included: mean change in visual acuity (VA), mean change in central macular thickness (CMT), mean change in macular volume (MV), as efficacy measurements and mean change in intraocular pressure (IOP), as safety assessment. Treatment history, and all assessments were collected at baseline. This study adhered to the tenets of the Declaration of Helsinki and all patients provided informed consent.
At baseline, before switch to FAc, mean ±standard deviation of VA, CMT, MV and IOP was 45.4±15.7 ETDRS letters, 546.1±169.5 μm, 11.1±2.9 mm3, and 14.7±5.6 mmHg, respectively. 82.6% of the patients received prior laser treatment. Other pre-FAc treatments included: % (mean number of injections): bevacizumab: 26.1% (0.86); ranibizumab: 56.2% (2.8); aflibercept: 18.2% (0.5); triamcinolone: 34.6% (1.0) and Dex.: 100% (1.7). After one implant of FAc, mean change in VA at month 6 showed an improvement statistically significant of 12.4 ETDRS letters (p ≤ 0,05). Mean change of CMT decreased by -206.3 μm (p ≤ 0,05). Mean change of MV decreased by -1.6 mm3 (p=0,063). The safety assessment (IOP) showed no concerns, with a mean change from baseline of -0.3 mmHg at the end of the 6 month follow-up.
Most of the eyes demonstrated an anatomical and visual improvement after switching to FAc, although in these case series, patients were treated with FAc as the last resource. Accordingly to EARLY study, we suggest FAc may be beneficial in patients if treated early after failure of anti-VEGF therapy. FAc is a long term treatment with continuous micro-dosing, thus avoiding recurrence of edema that may lead to irreversible retinal damage.
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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