Author: Joana Roque (Portugal)
Co-authors: Catarina Monteiro, Júlio Almeida, Mafalda Mota, Inês Coutinho, Graça Pires, Isabel Prieto
Purpose
To describe a case of unilateral Fluocinolone Acetonide (FAc) implant for recurrent Diabetic Macular Edema (DME) which was complicated by medically uncontrolled severe glaucoma. We analysed the five-year outcomes of this long-acting corticosteroid implant compared with the repeated anti-VEGF injections in the contralateral “case-control” eye.
Setting/Venue
Hospital Prof. Doutor Fernando Fonseca, Amadora, Lisbon, Portugal
Methods
Retrospective medical chart review including clinical and imaging investigations.
Results
We present the case of a poorly controlled type 2 diabetic male with mild ocular hypertension, which was treated with repeated anti-VEGF and triamcinolone injections for recurrent bilateral DME for three years. At the age 59 years old, OD was injected with a FAc intravitreal implant (baseline BCVA OD 20/50, OS 20/25). DME rapidly subsided to the FAc implant but approximately one year after the injection this eye showed significantly raised IOP refractory to maximum medical therapy and laser trabeculoplasty. OD was subsequently subject to trabeculectomy, allowing IOP control without the need for topical medication. This eye has exhibited sustained visual acuity (BCVA OD 20/25) and stable retinal thickness for 60 months without any additional interventions. Despite preservation of central vision, glaucomatous damage was severe, conditioning a significant inferior visual field defect. During the same follow-up period, the fellow eye has been managed with repeated anti-VEGF injections (n=22). Recurrent DME OS has been accompanied by macular structural changes and progressively worsening visual results (BCVA OS ≤20/100). Surprisingly, the patient reports having better vision in his left eye.
Conlusions
FAc intravitreal implant is an effective treatment for recurrent DME but may be complicated by challenging cases of steroid-induced glaucoma. In this case, the FAc implant has provided excellent and longstanding outcomes in terms of macular edema. Nonetheless, the steroid-induced glaucomatous damage was equally pronounced in this patient. The dilemma still persists if this was a fair cost for the outstanding preservation of central vision, without the burden of repeated intravitreal injections. The authors recommend a careful selection of DME patients for FAc intravitreal implant, as well as an attentive approach towards IOP adverse events.
Financial Disclosure
No finantial interests
Comments
-
