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
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.
retrospective, single centre chart review
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.)
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.
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.