Fluocinolone acetonide intravitreal implant for treatment of diabetic macular edema. Long term real life results

Session Details

Session Title: Free Paper Session 19: Vascular Diseases & Diabetic Retinopathy V

Session Date/Time: Saturday 09/09/2017 | 16:30-18:00

Paper Time: 17:18

Venue: Room 120

First Author: : M.Rehak GERMANY

Co Author(s): :    M. Tuisl   C. Jochmann   P. Wiedemann                       

Abstract Details

Purpose:

In the retrospective single centre study, we evaluated the effectiveness of fluocinolone acetonide implant (Iluvien®) in patients with diabetic macular edema (DME) who were insufficiently responsive to anti-VEGF therapy.

Setting:

retrospective, single centre chart review

Methods:

In total 30 eyes of 30 patients initially treated with 3-14 anti-VEGF injections (ranibizumab and/or aflibicerp) without significant improvement of best corrected visual acuity (BCVA) and central foveal thickness (CFT) were analyzed. After anti-VEGF treatment, the direct switch to fluocinolone implant was performed in 16 eyes (group A), in 14 eyes dexamethasone (Ozurdex®®) was implanted (group B) before fluocinolone treatment was initiated. A complete ophthalmic examination with measurement of (BCVA in logMAR) and SD-OCT were performed at baseline and at all follow-up visits (after fluocinolone treatment at month 3, 6, 12, 18, 24, 30 and 36 after implantation.)

Results:

After anti-VEGF treatment, the BCVA improved only non-significantly from0.45±0.22 to 0.43±0.26 logMAR (p=0.46) and CFT from 513.3±176.1µm to 398.1±183.2µm. In the group A two months after dexamethasone implantation significant improvement of BCVA (from 0.46±0.23 to 0.36±0.21 logMAR; p=0.05) and CFT from 485.7±163.1µm to 293.4±175.2µm; p=0.048) was observed. At month 4 after dexamethasone implant BCVA decreased to 0.41±0.24 logMAR and CFT increased to 371.9±167.1µm. The baseline BCVA and CFT before implantation of fluocinolone was in all 30 eyes 0.48±16 logMAR and 432.7±191.5µm respectively and improved significantly at month 3 and 6 to 0.36±0.21 logMAR and 0.38±0.22 logMAR with 278.2±142.3µm and 289.6±158.3µm respectively (p=0.012). At the final visit with mean of follow-up of 15.8 months (range: 4-31 months) the CFT was 289.4±176.3µm (p=0.03) and BCVA was 0.40±0.26 logMAR in all phakic and pseudophakic eyes (p=0.06). If only pseudophakic eyes were analyzed, the significant improvement of BCVA remained preserved (0.38±0.24 logMAR; p=0.04). The elevation of IOP was observed in 7 (23%) eyes and could be treated with IOP lowering drops without surgical intervention.

Conclusions:

The results of our retrospective analysis showed that fluocinolone implant is an effective treatment for DME eyes not responding to anti-VEGF treatment. The improvement of BCVA and reduction of CFT was observed up to 31 months after the implantation.

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