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Manuel Falcao, Marta Inês Silva, Tânia Carolina Madeira, Vitor Adriano Fernandes, Vitor Rosas, Flávio Alves, Fernando Falcao-Reis; RETINAL NERVE FIBER LAYER THICKNESS CHANGES AFTER INTRAVITREAL FLUOCINOLONE ACETONIDE IMPLANT FOR CHRONIC DIABETIC MACULAR EDEMA. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1912.
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The fluocinolone acetonide implant lasts up to three years in the vitreous of implanted eyes releasing a mean 0.2 μg/day. The aim of this retrospective analysis is to determine the effects of the implant on the retinal nerve fiber layer (RNFL) in chronic diabetic macular edema (DME) eyeas as measured by the spectral domain optical coherence tomography (SD-OCT).
Data was collected from 6 patients (6 eyes) with DME who had received a single intravitreal fluocinolone acetonide implant after suboptimal response to prior combinations of DME treatments. All eyes had been previously treated with other corticosteroids (4 with a dexamethasone implant and 5 with triamcinolone). None had had a significant rise in intra-ocular pressures (IOP) with the previous corticosteroid treatments. Eyes were followed for 18 months. Peripapillary SD-OCT (Spectralis Heidelberg) RNFL thickness measurements were obtained at baseline, 6, 12 and 18 months. The follow-up function of the device was used to ensure the measurements were performed in the same locations throughout the study period. Secondary analysis included changes in IOP, best-corrected visual acuity and central macular thickness.
6 patients (6 eyes) were included. All patients were pseudophakic at baseline. Prior DME therapies included anti-VEGF (range, 0 to 8) and/or corticosteroid (range, 1 to 4). At baseline mean RNFL thickness was 108.5±15.9 µm. At 6, 12 and 18 moths the RNFL thickness was 102.8±14.9, 103.8±14.2 and 105±16.2µm respectively. There were no statistically significant differences from baseline to any of the timepoints (p>0.23). There were no statisticall significant differences in IOP or visual acuity in the 18 months even though there was a statistically signficant decrease in macular thickness.
The use of the fluocinoloe implant did not lead to a reduction of the RNFL thickness in our small subset of patients who had been previously treated with intravitreal steroids without significant IOP increases. Testing short-acting steroids for changes in IOP may help predict the IOP response to fluocinolone acetonide. This may be helpful in deciding which patients have a lower risk of IOP rise with the fluocinolone implant and prevent glaucomatous optic nerve damage that can be associated with the use of long-lasting steroids.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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