First Author: F.Kretz GERMANY
Co Author(s): K. Linz G. Auffarth 0 0 0 0 0 0 0 0 0
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Evaluation of bilateral implantation of a Fluocinolone acetonide intravitreal implant (Iluvien®) in a patient with a therapy resistant macular edema.
International Vision Correction and Research Centre (IVCRC) & David J Apple Laboratory
An 87-year-old patient with a diabetic Retinopathy was treated consecutively for diabetic macular edema within 5 years. The first consultation was in May 2009 presenting a diabetic maculopathy. In-between 2009 and 2013 both eyes were treated with focal laser photocoagulation and multiple intravitreal injections of Anti-VEGF and Triamcinolon. The following intravitreal injections were performed: on the left eye Triamcinolon (n=3), Avastin (n=5) and Lucentis (n=4), on the right eye Triamcinolon (n=2), Avastin (n=3) and Lucentis (n=5). Due to persistent diabetic macular edema Iluvien was implanted on both eyes. Follow up examinations included visual acuity, OCT and intraocular pressure measurements.
At one month after the implantation of Iluvien, uncorrected distance visual acuity (UDVA) increased to 0.58 logMAR compared to preoperative UDVA of 0.7 logMAR on the right eye. On the left eye UDVA increased to 0.9 logMAR compared to preoperative UDVA of 1.0 logMAR. In the 3-months follow-up visit the UDVA improved to 0.46 logMAR on the right eye and to 0.88 logMAR on the left eye. The intraocular pressure remained stable on both eyes at 13 and 12 mmHg compared to preoperative measurements. Retinal thickening at the center of the macular has been reduced on both eyes.
The implantation of Iluvien offers a sight-saving option for patients with chronic diabetic edema who were previously treated with laser photocoagulation, intravitreal injections of Anti-VEGF or steroids without a sufficient response to the therapy. The long testing effect also reduces the amount of intravitreal injections and possible risks of complications.