Iluvien™ (Fluocinolone Acetonide 0.19 mg Intravitreal Implant) in the Treatment of Diabetic Macular Edema: A Review

Fusi-Rubiano, William; Blow, Rebecca R.; Lane, Mark A.; Morjaria, Rupal; Denniston, Alastair K

doi:10.1007/s40123-018-0145-7

Cited by 26 publications

(23 citation statements)

References 43 publications

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“…Both the dexamethasone and FAc implants are effective and have tolerable safety profiles for the treatment of DME [11,[18][19][20][21]. However, the FAc implant may offer improved convenience and a reduced clinical burden compared with the dexamethasone implant.…”

Section: Introductionmentioning

confidence: 99%

Outcomes in diabetic macular edema switched directly or after a dexamethasone implant to a fluocinolone acetonide intravitreal implant following anti-VEGF treatment

et al. 2019

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Aims Fluocinolone acetonide (FAc) is an intravitreal corticosteroid implant approved for the second-line treatment of diabetic macular edema (DME). This study compared outcomes of patients with DME switched directly to an FAc implant, versus indirectly via dexamethasone, after anti-VEGF therapy failure. Methods This is a retrospective, single-center chart review. Patients were assigned to Group A (switched to FAc after anti-VEGF) or Group B (switched to dexamethasone and then to FAc after > 4 months). Charts were reviewed for best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP) and cataract development. Results Forty-nine eyes were included. BCVA increased and CMT decreased with anti-VEGF (both groups), and dexamethasone (Group B only), but regressed after stopping treatment. With FAc, BCVA increased rapidly and significantly: increases were maintained up to 36 months (P < 0.001), except at 18 and 9 months in Groups A and B, respectively. Significant CMT reductions (P < 0.001) were evident after 3 months and maintained up to 36 months in both groups. IOP increase > 21 mmHg occurred in 14 patients (nine in Group A, five in Group B): all were sufficiently treated with IOP-lowering drops. Nineteen phakic eyes (73.1%) developed cataract: seven underwent phaco-emulsification (two in Group A, five in Group B). Conclusions Similar functional and anatomical improvements occurred in FAc-treated eyes, regardless of whether they first received dexamethasone or switched directly to FAc after anti-VEGF. Safety signals were consistent with corticosteroid class effects. Early switch to FAc could benefit patients who respond insufficiently to anti-VEGF. Keywords Diabetic macular edema • Fluocinolone acetonide • Dexamethasone • Second-line treatment • Best-corrected visual acuity • Central macular thickness This article belongs to the topical collection Eye Complications of Diabetes managed by Giuseppe Querques.

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Section: Introductionmentioning

confidence: 99%

Outcomes in diabetic macular edema switched directly or after a dexamethasone implant to a fluocinolone acetonide intravitreal implant following anti-VEGF treatment

et al. 2019

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“…Iluvien® implant (Alimera Sciences Inc., Alpharetta, GA, USA) is a sustained release biodegradable implant which provides a therapeutic intravitreal concentration of fluocinolone acetonide for up to 36 months. 1 , 2 …”

Section: Introductionmentioning

confidence: 99%

Anterior migration of intravitreal fluocinolone acetonide (Iluvien®) implant in a pseudophakic eye with intact posterior capsule

Alzaabi

Taguri

Elbarky

2020

American Journal of Ophthalmology Case Reports

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Purpose To describe a case of spontaneous anterior migration of intravitreal fluocinolone acetonide (Iluvien®) implant in a pseudophakic eye with intact posterior capsule. Observation A 60-year old woman with proliferative diabetic retinopathy underwent uneventful pars plana vitrectomy and phacoemulsification with posterior chamber intraocular lens (PCIOL) implants in both eyes. She developed diabetic macular edema (DME) in her right eye which failed to respond to repeated intravitreal injections of Aflibercept 2mg/0.05ml (Eylea®). The patient received an intravitreal Iluvien® implant to treat the recalcitrant DME after she showed a favorable temporary response to dexamethasone intravitreal implant (Ozurdex™).Six months later she presented with pain in the right eye due to elevated intraocular pressure (IOP). The Iluvien® implant was found to be dislodged into the anterior chamber (AC) in the presence of an intact posterior capsule and stable PCIOL implant. The migrated Iluvien implant was removed and IOP was controlled with a glaucoma drainage valve as it failed to respond to maximum anti-glaucoma medication. Conclusions and Importance Intravitreal Iluvien® implant could migrate into the AC in a previously vitrectomized eyes in the presence of an intact posterior capsule.

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“… 11 , 12 Given the increased recognition of the role of inflammation in the development of DME, intravitreal corticosteroid therapy has been shown to provide promising anatomical and visual benefits, especially when compared to laser therapy. 13 – 15 Compared to anti-VEGF therapy, intraocular corticosteroids do carry class-specific risks such as cataract progression and ocular hypertension that theoretically could be downplayed in abstract presentation. 15 The purpose of this study was to examine the relationship between industry funding and the presence of spin in high-impact studies assessing the efficacy and safety of intravitreal corticosteroid therapy for DME.…”

Section: Introductionmentioning

confidence: 99%

“… 13 – 15 Compared to anti-VEGF therapy, intraocular corticosteroids do carry class-specific risks such as cataract progression and ocular hypertension that theoretically could be downplayed in abstract presentation. 15 The purpose of this study was to examine the relationship between industry funding and the presence of spin in high-impact studies assessing the efficacy and safety of intravitreal corticosteroid therapy for DME.…”

Section: Introductionmentioning

confidence: 99%

<p>Analysis of Funding Source and Spin in the Reporting of Studies of Intravitreal Corticosteroid Therapy for Diabetic Macular Edema: A Systematic Review</p>

Nithianandan¹,

Kuriyan²,

Venincasa³

et al. 2020

OPTH

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This systematic review examined the relationship between industry funding and the presence of spin in high-impact studies evaluating intravitreal corticosteroid therapy for diabetic macular edema. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE and Embase were systematically searched from inception through July 16, 2018, for randomized controlled trials and meta-analyses investigating the treatment of patients with diabetic macular edema using intravitreal corticosteroid therapy. Only studies published in English journals with an impact factor greater than 2 as per the Clarivate Analytics 2017 Journal Citation Report were included. The authors independently assessed study quality, funding source and the presence of reporting bias using a standardized datasheet. Results: Title and abstract screening were completed on 7158 unique hits and full-text review yielded 44 included studies. Overall, there was correspondence between the wording of abstract conclusions and study results in 41/44 (93%) articles. Correspondence between abstract conclusions and significance of main outcome was present in 14/14 (100%) industryfunded and 27/30 (90%) nonindustry-funded studies. The odds ratio of industry funding being associated with noncorrespondence was 0.27 (95% CI: 0.01-5.61, p=0.54). The most common reason for noncorrespondence was the failure to mention rates of steroid-related intraocular pressure elevation. Conclusion: The results of this systematic review indicate that biased abstract outcome reporting is rare in published randomized controlled trials and meta-analyses of intravitreal corticosteroid therapy for diabetic macular edema. Biased reporting was not associated with the presence of industry funding or a conflict of interest.

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Iluvien™ (Fluocinolone Acetonide 0.19 mg Intravitreal Implant) in the Treatment of Diabetic Macular Edema: A Review

Cited by 26 publications

References 43 publications

Outcomes in diabetic macular edema switched directly or after a dexamethasone implant to a fluocinolone acetonide intravitreal implant following anti-VEGF treatment

Outcomes in diabetic macular edema switched directly or after a dexamethasone implant to a fluocinolone acetonide intravitreal implant following anti-VEGF treatment

Anterior migration of intravitreal fluocinolone acetonide (Iluvien®) implant in a pseudophakic eye with intact posterior capsule

<p>Analysis of Funding Source and Spin in the Reporting of Studies of Intravitreal Corticosteroid Therapy for Diabetic Macular Edema: A Systematic Review</p>

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