Author: Renato Correia Barbosa (Portugal)
Co-authors: Carla Teixeira, Ricardo Bastos, Sara Alves, Rita Basto, Ana Rita Viana, Paula Tenedório
Purpose
Vascular endothelial growth factor inhibitors (anti-VEGF) and intravitreal corticosteroids are the current main therapeutic strategies to manage Diabetic Macular Edema (DME). Treatment goals include resolution of the edema, stabilization or improvement of vision, and a reduction in morbidity translated by reduced frequency of injections and adverse events. In this case report, we present a clinical case of recurrent DME, despite treatment with multiple anti-VEGF, triamcinolome and dexamethasone implants, which was then submitted to a fluocinolone acetonide 0,19mg, ILUVIEN® implant.
Setting/Venue
The diagnosis and treatment of this recurrent DME case took place in the department of ophthalmology of Hospital Pedro Hispano – Unidade Local de Saúde de Matosinhos, Portugal, in 2020.
Methods
Clinical case of an unilateral recurrent DME, previously treated with multiple intravitreal anti-VEGF and corticosteroids, and subsequent stabilization after fluocinolone acetonide 0,19mg, ILUVIEN® implant during the 39 month follow-up period, without further need for treatment.
Results
A 77-year-old female patient, diagnosed with Diabetes Mellitus type 2 for 32 years, developed bilateral non-proliferative diabetic retinopathy and DME in the right eye (OD). OD was treated with panretinal photocoagulation and 3 ranibizumab intravitreal injections, achieving a best corrected visual acuity (BCVA) of 79 early treatment diabetic retinopathy study (ETDRS) letters. Although responsive to treatment, DME in the OD recurred after 8 months, and she underwent an intravitreal injection of triamcinolone, with temporary anatomical and functional improvement, which relapsed again, after 3 months. She was then injected with 3 successive dexamethasone implants, with temporary improvement, but DME relapsed 4-6 months after each procedure. Due to the multiple recurrences, the next treatment strategy consisted on fluocinolone acetonide 0,19mg, ILUVIEN® implant, which preserved normal macular thickness and function (84 ETDRS letters) during the 39 months of follow-up after the procedure. Intra ocular pressures remained stable, without need for hypotensive drugs usage.
Conlusions
The sustained release fluocinolone acetonide implant effectively restored and preserved macular thickness, which resulted in improved visual function, prevailing during the 39 months of follow-up. There were no visual adverse events during this period. This treatment demonstrated to be a therapeutical option in cases of corticoid responsive DME with successive relapses.
Financial Disclosure
There are no financial relations with any company.
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