Long-term Benefit of Sustained-Delivery Fluocinolone Acetonide Vitreous Inserts for Diabetic Macular Edema

A review of therapies for diabetic macular oedema and rationale for combination therapy

“…The mean improvement in BCVA letter score between baseline and month 24 was 4.4 and 5.4 in the 0.2 and 0.5 μg groups. 47 There was a significant reduction in macular oedema. Further analysis suggested that fluocinolone was more effective in eyes with long-standing DMO, where chronic inflammation was more important than the VEGFmediated oedema.…”

“…36,[42][43][44][45][46][47][48] These treatments are summarised in Table 1. These treatments are particularly useful in eyes with centre-involving DMO.…”

“…[36][37][38][39][40][41]43 Several clinical studies have investigated the efficacy of steroids, such as triamcinolone, fluocinolone, and dexamethasone, in the treatment of DMO. 13,42,[46][47][48][49][50][51] Corticosteroids may reduce DMO by targeting the non-VEGF-dependent inflammatory pathways including blockage of the arachidonic acid pathway (reduction of prostaglandin synthesis), and inhibition of the release of proinflammatory mediators, including VEGF. This may be through modulation of EC TJ molecules.…”

Long-Term Outcome of Approved Pharmacotherapy for Diabetic Macular Edema: A Review of Randomized Controlled Trials in Fluocinolone Acetonide Implants, Dexamethasone Implants, Aflibercept and Ranibizumab

“…Intravitreal injections of anti-VEGF, including ranibizumab [2][3][4][5][6][7][8], bevacizuamb [9], pegaptanib [10], aflibercept [11] are proven to be effective for managing DME. Intravitreal injections of corticosteroids, potent anti-inflammatory agents, such as fluocinolone acetonide implants (Retisert) [12], fluocinolone acetonide inserts (Iluvein) [13,14], dexamethasone implants [15,16], and triamcinolone acetonide [2] have been shown to be beneficial to DME. The Food and Drug Administration of US and European Medicines Agency have approved intravitreal injections of fluocinolone acetonide inserts (Iluvein), dexamethasone implants, aflibercept, and ranibizumab for treating DME.…”

“…The FAME study collected subjects with persistent DME despite at least 1 macular laser treatment. The patients were randomized into 375 eyes receiving fluocinolone acetonide low-dose insert (0.2 μg/day), 393 eyes in high-dose insert (0.5 μg/day), and 185 eyes in sham injections [13]. Significant visual improvement occurred for both doses compared with sham since three weeks following single intravitreal injection.…”