Abstract
Purpose :
Optimising medicines usage remains a focus as healthcare resources continue to shrink. We performed a retrospective, observational study in diabetic macular edema (DME) patients treated with the ILUVIEN (0.2µg/day fluocinolone acetonide; FAc) implant to understand the impact of disease duration on outcomes.
Methods :
We analysed DME patient records treated with the FAc implant between 02/2014 and 11/2017. Baseline parameters included the duration of DME, prior intravitreal therapies, history of vitrectomy and tractional pathologies, and retinopathy status. We analysed changes in visual acuity (VA, Early Treatment Diabetic Retinopathy Study [ETDRS] letters), central macular thickness (CMT, µm), maximum macular thickness (MMT, µm), intraocular pressure (IOP, mmHg), and recorded any further treatment for DME or ocular hypertension (OHT). Two sub-groups were compared: those with baseline DME duration below the mean of 25 months (shorter DME duration), or ≥25 months (longer DME duration). Groups were compared using unpaired tests: Student’s t-test, Wilcoxon (Mann-Whitney U test)) and Fischer’s exact test.
Results :
Of the 84 eyes treated, 59.5% had shorter DME duration and 40.5% had longer DME duration; the duration of follow-up for each group was 28.7 months ±10.9 (mean ±standard deviation) and 26.1 months ±10.3, respectively.
At last observation, shorter DME duration was associated with larger VA gains (+5.4 vs -1.5 letters, P=0.0566, see image 1), a greater reduction in central (-151.7 vs. -88.1 microns, P=0.0141) and maximum macular thickness (-157.6 vs. -91.9 microns, P=0.008) from baseline, and higher rates of anatomical response (defined as a reduction of ≥20% from baseline) for CMT (P=0.0132) and MMT (P=0.0110). Supplementary treatments were given in a lower percentage of patients with shorter compared with longer DMO duration (34.0% vs 50.0%). Furthermore, there were lower rates of surgical intervention for OHT observed in the shorter DMO duration sub-group (n=1 and 3, respectively). See Table 1.
Conclusions :
Our results demonstrate the anatomical and functional benefits of considering earlier treatment with FAc implant in the course of DME disease, or earlier conversion of treatment to the use of slow release steroid implants. These results could help optimise future management plans for DME. Limitations of the study include being retrospective and the differences in baseline characteristics that may have impacted on results.
This is a 2021 ARVO Annual Meeting abstract.