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Ana M Suelves, Dominic Buzzacco, Louis Chorich III, Sugat Patel; Fluocinolone acetonide for persisting diabetic macular edema in routine clinical practice in the US. Long-term follow up.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4819.
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Although intravitreal anti-vascular endothelial growth factor injections are considered the mainstay of diabetic macular edema (DME), some diabetic patients have a refractory DME despite multiple treatments. It poses a management challenge to retina specialists and an emotional burden for patients and their families. We performed a retrospective, observational, clinical study to analyze results of patients with persistent DME that received an intravitreal fluocinolone acetonide (FA).
A retrospective review was performed on 12 patients (16 eyes) with persistent DME treated with a FA implant and followed at least 12 months. The main outcome measures were: central retinal thickness (CRT) and best-corrected visual acuity (BCVA) before and after treatment. Information collected included demographic, clinical characteristics and treatments before and after FA implant.
The mean age was 72.8 ± 7.9 years (range 60-92 years). At baseline, five patients (5 eyes) had a prior history of pars plana vitrectomy and all patients were pseudophakic. Eleven out of 12 patients had type 2 diabetes. Initial central retinal thickness (CRT) was 443.0±142 microns (mean ± standard deviation). At the end of follow up, mean CRT improved significantly in all patients to 280.0±97.1 microns (p=0.0001). The mean logMAR BCVA improved from 0.66 ± 0.37 to 0.41± 0.18 (p=0.0017). Only one patient required glaucoma medications to control intraocular pressure. Six patients (7 eyes) did not require any other treatment after the implantation of FA.
Fluocinolone acetonide is effective and safe in persistent DME. It provided long-term stability of DME in half of the patients in our cohort and reduced the treatment burden in the rest of our patients. This study provides further evidence that combination therapy may provide a good outcome among eyes with persistent DME following anti-VEGF therapy.
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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