Treatment of refractory diabetic macular edema with a fluocinolone acetonide implant in vitrectomized and non-vitrectomized eyes

Mantia, Alberto La; Hawrami, Alan; Laviers, Heidi; Patra, Sudeshna; Zambarakji, Hadi

doi:10.18240/ijo.2018.12.13

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…Studies that evaluated the functional efficacy of the FAc implant ( n = 22 studies) had a mean follow-up of 20.0 months (range: 8.5–36.0 months, median: 18.0 months) [ 15 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Mean baseline BCVA was 50.8 letters (range: 45.7–71.0 letters, median: 51.6 letters) and improved to a maximum of 59.5 letters (range: 49.0–74.8 letters, median: 57.2 letters) after FAc implant injection.…”

Section: Resultsmentioning

confidence: 99%

Real-World Efficacy and Safety of Fluocinolone Acetonide Implant for Diabetic Macular Edema: A Systematic Review

et al. 2021

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To assess real-world outcomes of fluocinolone acetonide (FAc) implant in treating diabetic macular edema (DME), a systematic literature review was conducted on PubMed in order to identify publications assessing the efficacy and safety of the FAc implant in DME in daily practice. Case reports and randomized controlled trials were excluded. Twenty-two observational real-world studies analyzing a total of 1880 eyes were included. Mean peak visual gain was +8.7 letters (11.3 months post-FAc injection) and was greater for lower baseline best corrected visual acuity (BCVA) and for more recent DME. Mean central retinal thickness (CRT) decreased 34.3% from baseline. 77.0% of the analyzed studies reported both BCVA improvement of at least five letters and a CRT decrease by 20% or more. Rescue therapy was needed more frequently when FAc was administered for chronic DME. FAc-induced ocular hypertension was reported in 20.1% of patients but only 0.6% needed surgery. Cataract extraction was performed in 43.2% of phakic patients. Adequate patient selection is essential for optimal FAc response and better safety profile. Currently positioned as second- or third-line treatment in the management algorithm, FAc implant decreases treatment burden and provides better letter gain when administered for more recent DME.

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Section: Resultsmentioning

confidence: 99%

Real-World Efficacy and Safety of Fluocinolone Acetonide Implant for Diabetic Macular Edema: A Systematic Review

et al. 2021

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“…The 0.59 mg intravitreal FA implant (Retisert; Bausch + Lomb; Rochester, NY, USA) requires surgical implantation but can provided years of therapy, whereas the more recently developed 0.19 mg intravitreal FA implant (Iluvien; Alimera Sciences Inc; Alpharetta, GA, USA) is an injectable implant that can be performed in clinic which can also last for a year or longer. Multiple studies have investigated the intravitreal FA implant in the treatment of anti-VEGF-resistant DME with beneficial, sustained visual acuity and macular thickness results [ 122 , 123 , 124 , 125 , 126 , 127 , 128 ]. Compared to the DEX implant, the 0.19 mg intravitreal FA implant offers continuous steroid therapy for longer treatment intervals (about 4 months compared to 8–24 months).…”

Section: Diabetic Retinopathy and Diabetic Macular Edemamentioning

confidence: 99%

Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options

Wallsh

Gallemore

2021

Cells

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Anti-vascular endothelial growth factor (anti-VEGF) therapy currently plays a central role in the treatment of numerous retinal diseases, most notably exudative age-related macular degeneration (eAMD), diabetic retinopathy and retinal vein occlusions. While offering significant functional and anatomic benefits in most patients, there exists a subset of 15–40% of eyes that fail to respond or only partially respond. For these cases, various treatment options have been explored with a range of outcomes. These options include steroid injections, laser treatment (both thermal therapy for retinal vascular diseases and photodynamic therapy for eAMD), abbreviated anti-VEGF treatment intervals, switching anti-VEGF agents and topical medications. In this article, we review the effectiveness of these treatment options along with a discussion of the current research into future directions for anti-VEGF-resistant eyes.

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“…However, up to 66% of patients can have an insufficient response, despite initial intensive monthly anti-VEGF therapy [ 5 ]. This presents a substantial treatment burden for patients and healthcare providers; patients may be reluctant to receive such treatment and may miss clinic follow-up visits because of other hospital appointments [ 6 ]. The current Covid-19 pandemic has shown that it would be beneficial to have treatments that require fewer injection visits and/or less frequent clinic visits.…”

Section: Introductionmentioning

confidence: 99%

Extended real-world experience with the ILUVIEN® (fluocinolone acetonide) implant in the United Kingdom: 3-year results from the Medisoft® audit study

Bailey

Chakravarthy

Lotery

et al. 2021

Eye

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Background This study aimed to assess the long-term effectiveness of the 0.2 μg/day fluocinolone acetonide (FAc) implant over ≥3 years for patients with diabetic macular oedema. Methods A retrospective audit of pseudo-anonymised data from patients with chronic diabetic macular oedema (cDMO) and treated with the FAc implant across 14 UK clinical sites. Safety and clinical effectiveness were measured. Results Two-hundred and fifty-six eyes had ≥3 years of follow-up (mean 4.28 years), during which a mean of 1.14 FAc implants were used per eye. Mean best-recorded visual acuity (BRVA) increased from 52.6 to 56.7 letters at month 3 and remained stable thereafter; this trend was also seen in pseudophakic eyes. The proportion of patients attaining a BRVA ≥6/12 increased from 17% at baseline to 27% 1 month after FAc implant and remained stable above 30% from month 12 onwards. Eyes with no prior history of intraocular pressure (IOP)-related events required significantly less treatment-emergent IOP-lowering medication than those with a prior history of IOP events (17.9% vs. 50.0% of eyes; p < 0.001). The incidence of an IOP increase of ≥10 mmHg, use of IOP-lowering medication, laser trabeculoplasty and IOP-lowering surgery was 28.9%, 29.7%, 0.8% and 2.7%, respectively, for the whole cohort. There were significant reductions in mean central foveal thickness and macular volume (p < 0.001). Conclusions The FAc implant was well tolerated, with predictable and manageable IOP-related events while delivering a continuous microdose of corticosteroid to eyes with cDMO, providing prolonged vision preservation and a reduced number of treatments.

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Treatment of refractory diabetic macular edema with a fluocinolone acetonide implant in vitrectomized and non-vitrectomized eyes

Cited by 6 publications

References 20 publications

Real-World Efficacy and Safety of Fluocinolone Acetonide Implant for Diabetic Macular Edema: A Systematic Review

Real-World Efficacy and Safety of Fluocinolone Acetonide Implant for Diabetic Macular Edema: A Systematic Review

Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options

Extended real-world experience with the ILUVIEN® (fluocinolone acetonide) implant in the United Kingdom: 3-year results from the Medisoft® audit study

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