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S. Ahmad, S.S. Stinnett, G.J. Jaffe; Pre–Treatment Prognosticators of Response to a Fluocinolone Acetonide Implant for Diabetic Macular Edema . Invest. Ophthalmol. Vis. Sci. 2006;47(13):979.
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To determine whether pre–treatment clinical variables, and fluorescein angiography (FA) and optical coherence tomographic (OCT) findings correlate with subsequent response to a fluocinolone acetonide intravitreal implant in eyes with diabetic macular edema (DME).
The study design was a retrospective review of prospectively collected data in 126 eyes who were followed after implantation of a 0.59 mg fluocinolone acetonide intravitreal implant for DME. Baseline data was collected along with follow–up data 3 months and 6 months after implantation, and every 6 months thereafter up to 3 years. Pre–treatment medical history, clinical exam, and fluorescein angiography data were recorded for each patient, as well as clinical exam findings on each follow–up visit. Pre–treatment and follow–up OCT scans were assessed in a random subset of 29 patients for central foveal thickness (CFT), volumetric measures, and presence of cystic changes, large cystoid spaces (>250 microns), subfoveal fluid, epiretinal membrane (ERM) and vitreomacular attachment (VMA). Statistical analyses were carried out examining correlations between and among pre– and post–treatment variables.
Pre–treatment BCVA directly correlated with maximal post–implantation BCVA (p<0.001). Pre–treatment chronicity of diabetes mellitus (in years) and severity of DME (graded on clinical examination) both inversely correlated with maximal post–implantation BCVA (p=0.03 for both). Patients with cardiovascular disease were more likely to experience visual acuity worsening after implantation (p=0.007). Eyes with pre–treatment VMA had more residual post–implantation retinal edema (p=0.05), less visual acuity improvement (p=0.04), and were more likely to experience worse visual acuity (p=0.02) after implantation. Large cystoid spaces on pre–treatment OCT were associated with greater post–implantation CFT reduction (p=0.02). Post–implantation edema resolution was associated with both a better post–implantation BCVA (p=0.005) and a tendency toward greater rise in intraocular pressure (p=0.03).
We have identified pre–treatment factors that may help predict changes in visual acuity and macular edema following fluocinolone acetonide implant placement in eyes with DME. This information may be useful in clinically determining which patients are most likely to benefit from this treatment modality.
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