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Nisha Dhawlikar, Sumit P. Shah, David L. Yarian, Jonathan Prenner, Eric S. Friedman, H. Matthew Wheatley, Howard F Fine, Dimosthenis Mantopoulos, Daniel B. Roth; One-Year Follow Up Results of Fluocinolone Acetonide Intravitreal Implant for Diabetic Macular Edema (DME) in Highly Treated Eyes. Invest. Ophthalmol. Vis. Sci. 2017;58(8):914.
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To determine the safety and efficacy of 0.19mg fluocinolone acetonide intravitreal implant for the treatment of DME in eyes with persistent edema despite treatment with alternative agents.
Patients treated with fluocinolone acetonide intravitreal implant were identified at a single retina only group practice. A retrospective study was conducted. All patients had prior treatment with one or more agents for DME (bevacizumab, ranibizumab, triamcinolone acetonide, or dexamethasone implant) prior to one fluocinolone acetonide intravitreal implant. Patients with 1-year follow up were included. Data analysis was performed in Stata.
19 eyes of 14 patients were identified. 4 were male and 10 were female (mean age: 69.6 years). 18 eyes were pseudophakic and 1 eye was phakic. Steroid challenge was performed with dexamethasone intravitreal implant (n=18 eyes) and intravitreal triamcinolone acetonide (n=1 eye). Average intraocular pressure (IOP) was 18.4 mmHg at baseline and 16.1 mmHg at follow up (p=0.02). Average central retinal thickness (CRT) was 380.1 μm at baseline and 287.1 μm at follow up (p=0.03). Average logMAR VA was 0.541 (Snellen 20/70) at baseline and 0.484 (Snellen 20/61) at follow up (p=0.26). Mean follow up was 370 days (range 341-413). IOP spike from steroid response after fluocinolone acetonide implant, at which time ocular hypertensive (OHT) medication was prescribed, occurred at a mean of 143 days (range 56-264, n=7). 5 eyes (26%) received rescue intravitreal injections (mean: 6, range 2-10) after fluocinolone acetonide. 8 eyes (42%) were on OHT medications at baseline and 11 eyes (58%) were on OHT medications at 1-year follow up (Table 1). 1 eye required selective laser trabeculoplasty. When stratified by rescue treatment, logMAR VA mean change was statistically significant (n=5, p=0.03). When stratified by OHT medication, IOP change was statistically significant (n=11, p=0.03).
Fluocinolone acetonide implant led to a statistically significant improvement in CRT in treatment-experienced eyes with DME. Steroid induced glaucoma can occur despite negative steroid challenge. IOP elevation due to steroid response after fluocinolone acetonide implant can present later than typically seen with other steroid agents. Baseline use of topical glaucoma therapy may confound the accurate assessment of steroid response at a baseline.
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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