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.