Session Title: Quick Fire Free Paper Session
Session Date/Time: Saturday 17/02/2018 | 11:45-13:00
Paper Time: 12:15
Venue: Ballroom II & III.
First Author: : J.Castro de Sousa PORTUGAL
Co Author(s): : D. Martins A. Sampaio H. Urbano P. Reis J. Nascimento C. Marques Neves
Corticosteroids have been shown to play a significant role in the treatment of diabetic macular edema (DME). The mechanism of action of corticosteroids is multifactorial. Corticosteroids act as anti-inflammatory drugs and antagonising the action of VEGF-A, inhibiting leukostasis and decreasing other inflammatory cytokines. Usually, intravitreal medications are cleared rapidly from the eye. To increase the duration of action, the medication may be dissolved slowly from a crystal structure (triamcinolone acetonide) or from a specific slow release device with a specific matrix (dexamethasone, fluocinolone acetonide). Extended-release steroid implants reduce the burden of injections and patients’ visits while effective in treating DME.
This is a retrospective study of 34 patients with DME from 8 centers who were previously treated with dexamethasone (Dex) and switched to fluocinolone acetonide (FAc) intravitreal implant. The aim was to report efficacy and safety outcomes in DME patients who switched from Dex to FAc.
This analysis included 34 eyes, 55.9% male and 44.1% female, with a mean age of 68.0±7.2 (mean±standard deviation) years and a mean duration of DME of 3.0±1.6 years. Outcomes were analyzed at 1, 3, 6, 9 and 12 months after FAc and included: mean change: 1) In visual acuity (VA), 2) In central macular thickness (CMT), 3) In macular volume (MV), as efficacy parameters and mean change of intraocular pressure (IOP), as safety assessment. Treatment history, and all assessments were collected at baseline. To avoid bias, results were adjusted to last observation.
At baseline 69.7% of the eyes were pseudophakic vs 30.3% phakic; 35.3% were vitrectomized and the remain 64.7% were non-vitrectomized. Besides dexamethasone implant, 91.2% of the patients received previous treatments for their eye disease. After one FAc implant, mean change in VA at last observation showed a statistically significant improvement of +7.56 letters (from a baseline value of 43.82±17.08 to 51.30±16.99 letters), (p ≤ 0.001). Mean CMT change was also statistically significant, from a baseline value of 559.73±166.82 to 438.15±169.61 μm (p ≤ 0.001). Mean change of MV decreased by -0.16 mm3, (p = 0.084). The safety assessment (IOP) showed no concerns, with a mean change from baseline of -0.68 mmHg, (p = 0.741).
Most of the eyes demonstrated an anatomical and visual improvement after switching to FAc implant, despite the fact that in these case series patients were treated with FAc as the last treatment resource. We suggest FAc may be beneficial in patients if treated earlier after the failure of anti-VEGF therapy, which is in accordance with the EARLY study. FAc is a long-term treatment with a continuous microdosing, consequently avoiding recurrence of edema, increasing regression of diabetic retinopathy and preventing disease progression.