Author: Renato Correia Barbosa (Portugal)
Co-authors: Carla Teixeira, Ricardo Bastos, Sara Alves, Rita Basto, Ana Rita Viana, Paula Tenedório
Purpose
Diabetic Macular Edema (DME) is a major cause in visual loss in developed countries. Chronic inflammation due to DME results in irreversible retinal damage, with serious impact in visual function. Therefore, early intervention is generally related to a better visual prognosis. Fluocinolone acetonide implant (FAc 0.2 μg/day, ILUVIEN®) is indicated for the treatment of chronic DME with sub-optimal response to previous therapeutic strategies. In this study, we compared the anatomical changes and functional response between eyes with recurrent DME treated with intravitreal Fac implant after early switch (≤ 6 previous intravitreal injections) and late switch (> 6 previous intravitreal injections).
Setting/Venue
The diagnosis and treatment of DME patients took place in the department of ophthalmology of Hospital Pedro Hispano – Unidade Local de Saúde de Matosinhos, Portugal.
Methods
A retrospective, non-randomized analysis of 109 eyes of 76 patients with recurrent DME was conducted. The eyes were divided into 2 groups, based on the number of previous intravitreal injections: the early switch group (group A), was composed by 34 eyes with ≤6 previous intravitreal injections, and the late switch group (group B) was composed by 75 eyes with >6 previous intravitreal injections. At baseline, the following outcomes were evaluated: 1) best corrected visual acuity (BCVA), measured with Early Treatment Diabetic Retinopathy Study (ETDRS) table; 2) number of previous intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections and short-acting corticosteroid injections; 3) duration of macular edema; 4) use of ocular hypotensive medication; 5) intraocular pressure (IOP); 6) central foveal thickness (CFT). Results were obtained based on the mean changes in BCVA, CFT and IOP recorded in the first month after the treatment and quarterly thereafter.
Results
At baseline, mean age was 70.0 ± 10.0 and 67.7 ± 8.2 years (p=0,3256) and mean DME duration was 4,3 ± 2.2 and 4.8 ± 1.8 years (p=0.4165), in group A and B, respectively. The average follow-up period was 27,4 ± 10.6 (A) and 26.0 ± 10.9 months (B) (p=0,545). All eyes received intravitreal injections prior to Fac implant (anti-VEGF 2.3 ± 1.5 [A] and 8.3 ± 3.4 [B] (p<0.001); short-acting steroids: 1.8 ± 1.3 [A] and 2.1 ± 1.7 [B] (p=0.3421)). Group A had a baseline BCVA of 51.2 ± 18.2 letters ETDRS, which increased by 10.7 letters at the last observation. Group B had a baseline BCVA of 48.5 ± 15.7 ETDRS letters, which increased 6.1 letters at the last observation (p=0,0018 between groups). Mean decrease in CFT was 171 μm (group A) and 149,9 μm (group B) (p=0,0823 between groups). IOP was stable during the follow-up period (Δ +1.9mmHg [A] and +0.6mmHg [B]), having been controlled with topical hypotensive drops, needed in 32% and 36% patients, respectively. Three years after the initial implant, 3.3% (group A) and 34.1% (group B) patients underwent Fac re-implantations (p=0,016).
Conlusions
Results showed a significant difference in functional outcome between early and late switch groups. Early switchers had superior visual results, which is probably related to chronic retinal dysfunction due to prolonged inflammation in late switchers. Anatomical outcomes, objectified by variation in CFT, showed a similar tendency favouring the early switch group, without reaching statistical significance. Early treatment with Fac implant may be linked with better visual outcomes in patients with DME.
Financial Disclosure
There are no financial relations with any company.
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