Abstract
Purpose :
In the management of Diabetic Macular Edema (DME), therapies such as focal laser photocoagulation, anti-vascular endothelial growth factor (anti-VEGF) and intravitreal steroids are paramount. While these therapies are relatively effective in treating DME, there are still considerable amounts of patients with recalcitrant edema, and frequent injections are needed, undoubtedly creating a burden on the patient and the treating physicians. This is a retrospective, cohort study evaluating the efficacy of continuous 0.2 µg/day Fluocinolone Acetonide (FAc) delivery when treating patients with persistent DME. We hypothesize that for persistent DME, improvements in Visual Acuity (VA) and Central Retinal Thickness (CRT) are maintained when switching from discontinuous treatments to continuous FAc therapy with the added benefit of reducing the frequency of treatment.
Methods :
A single-center, retrospective, cohort study of patients with persistent DME, previously treated with anti-VEGF injections, dexamethasone implants, or focal laser, who were subsequently treated with FAc was conducted. All retinal visits were analyzed prior to FAc, until the most recent follow-up visit. Primary outcomes included the change in the Best-Corrected Visual Acuity (BCVA), and the change in the average number of treatments-per-month from 36 months pre-FAc to the latest follow-up post-FAc. Secondary outcomes included the pre and post-FAc changes in CRT, and Intraocular Pressure (IOP).
Results :
19 eyes from 15 patients with persistent DME were included in the study. The mean (SD) follow-up after FAc was 399 (222) days. Overall, when switching from discontinuous to continuous therapy with FAc, the BCVA and CRT remained stabilized. BCVA improved by 0.4 EDTRS letters for all eyes at the latest follow-up after FAc (p = 0.895) and CRT decreased by 34.2 microns for all eyes (p = 0.077). Furthermore, the IOP increased from a mean of 15.9 to 18.6 (p=0.104). Upon FAc administration, 10/19 eyes (52.6%) did not require further treatment for DME. After FAc, the number of treatments required per month significantly decreased from an average of 1 treatment every 2.7 months to 1 treatment every 6 months (p = 0.009).
Conclusions :
In the setting of persistent DME, FAc significantly reduces treatment frequency, while maintaining BCVA and CRT outcomes.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.