First Author: D.Gosling UK
Co Author(s): R. Littlewood F. Quhill C. Brand
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In the UK National Health Service, guidelines by the National Institute for Health and Care Excellence positions the fluocinolone acetonide intravitreal implant (Iluvien®, Alimera Sciences) as a second line agent for pseudophakic eyes with chronic DMO. Treatment and follow up of patients with DMO can represent significant burdens to patients, employers, retina services and funding bodies. Does fluocinolone implant reduce the patient burden in terms of number of clinic visits and treatments when compared to the 12 months before treatment?
We report the 24 month ‘real-world’ performance of fluocinolone implant from our first cohort of treated patients in a large teaching hospital in Sheffield, UK.
A retrospective review of the electronic patient record (Medisoft) at a single UK ophthalmology department was undertaken. Data from consecutive eyes with a 24 month clinic follow up were included.
Between March and September 2014, 18 patients (21 eyes) received fluocinolone implant. 88% were male and 22% female, with a mean age of 63 years (range 43-81 years). 72% of patients were insulin dependent. 10 (48%) eyes needed no further treatment by 24 months. Of the 11 (52%), that required further treatment, 3 underwent macular/focal grid laser, 1 had pan-retinal photocoagulation, 8 had anti-VEGF therapy, and 3 required further intravitreal steroid therapy. Mean time to further treatment was 7 months (range 4-12 months). The mean number of annual clinic visits reduced from 9 per year in the 12 months before injection of fluocinolone implant, to 5 per year after (p<0.001). Mean annual intravitreal injections reduced from 5 per eye per year before injection of fluocinolone implant, to 1 per eye per year after the implant (p<0.001).
The real world data we present here, demonstrates that over a 24 month period, for patients with refractory DMO, fluocinolone implant reduced the number of eyes needing further treatment and provided a significant reduction in the number of clinic visits. This data suggests potential indirect economic savings for patients and employers, reduced costs to funding bodies and increased clinic availability for retina services.