Author: Rita Vieira (Portugal)
Co-authors: André Ferreira, Carolina Abreu, Sílvia Monteiro, Maria João Furtado, Miguel Lume
To analyze visual outcomes and safety of a fluocinolone acetonide (FA) sustained drug delivery implant (ILUVIEN®; Alimera Sciences Ltd, Hampshire, UK) for eyes with chronic macular edema due to central (CRVO) or branch retinal vein occlusion (BRVO).
Ophthalmology department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal.
Patients with central or branch retinal vein occlusion who were submitted to FA implant were included. The main objectives were to assess the changes in Best Corrected visual acuity (BCVA) and central macular thickness (CMT) six months after intravitreal injection. Secondary outcomes included the occurrence of ocular hypertension and cataract. Demographic data, time without edema after implant and the need for additional intravitreal injections during follow-up were also recorded. All patients were previously submitted to intravitreal anti-VEGF and steroids injections with dexamethasone implant or triamcinolone.
Eight eyes were enrolled. Mean age at diagnosis was 63±10.6 years-old. The mean±SD follow-up prior to FA implant was 4.75±2.73 years. Mean BCVA improved from 20/125 to 20/63 (p=0.154). Mean±SD CMT decreased from 567±144 to 455±191 micrometers (p=0.023). Ocular hypertension occurred in 2 patients (25%) and both were medically controlled. Of the four phakic patients before FA implant, 3 (75%) developed cataract within 6 months and were submitted to phacoemulsification. The mean±SD period without recurrence of macular edema was 4.0±3.3 months [1;10]. One patient (12.5%) remained without macular edema until the last follow-up (10 months after injection). Two patients (25%) were submitted to 4 monthly anti-VEGF injections immediately after FA implant. In these patients, the FA implant was used as an adjuvant treatment and they remained without macular edema until the last follow-up (18 and 9 months after last intravitreal injection, respectively). In four patients (50%), there was a recurrence of macular edema after a period without treatment: in three patients (37.5%) regular anti-VEGF injections were reintroduced and one patient (12.5%) was treated with dexamethasone implant. One patient (12.5%) didn’t respond to monthly treatment with anti-VEGF and lost follow-up. Mean follow-up after FA implant was 17.4±12.8 months.
Fluocinolone acetonide (FA) sustained drug delivery implant can be an option as an adjuvant or single therapy to treat chronic and irresponsive macular edema related to retinal vein occlusion, after partial response to other shorter action intravitreal steroids. According to our results, this therapy seems to be safe, since only two patients developed ocular hypertension controlled with topical medication. Prospective, randomized studies are necessary to understand the benefits of this implant in retinal vein occlusion’s macular edema.
The authors have nothing to declare.