Author: Jorge Leon-Garcia (Spain)
Co-authors: Pelayo Gonzalez-Secades, Esther Ciancas, Julio J Gonzalez-Lopez
Purpose
To describe the changes in best corrected visual acuity (BCVA) and optical coherence tomography (OCT)-measured central foveal thickness (CFT) in patients receiving an intravitreal flucinolone acetonide implant (Iluvien) for refractory inflammatory macular oedema.
Setting/Venue
Single, tertiary-care, university-affiliated hospital in Madrid, Spain.
Methods
A retrospective, observational case series including all patients having at least one eye treated with Iluvien for refractory inflammatory macular oedema, and a minimum follow-up time of 3 months. Only one eye per patient was included in the analysis. For patients who had both eyes treated, only the first eye was included in the analysis. All included eyes had a previous good response to intravitreal dexamethasone implant (Ozurdex), but required frequent re-injections. Patient records were reviewed by 2 of the authors, and data was recovered about their demographic characteristics (age, sex), time since the onset of the macular oedema, previous treatments (local and systemic), BCVA in each visit, OCT-measured CFT in each visit, and adverse events.
Results
Six eyes from 6 patients were included in the study. Median age was 71 years (range 60 to 75). Three were women (50%). All eyes were pseudophakic. Median baseline BCVA was 0.65 LogMAR (range 0.4 to 1.3), and median baseline central foveal thickness was 583.5 µm (range 406 to 778). Median follow-up time was 12 months (range 3 to 24 months). Median BCVA change was 0.0 logMAR at 1 month (range -0.6 to 0.2;p=0.655), 0.0 logMAR at 3 months (range -0.5 to 0.3;p=0.655), 0.0 logMAR at 6 months (range 0.0 to 0.3;p=0.180), 0.0 logMAR at 9 months (range -0.2 to 0.3;p=0.655), and -0.1 logMAR at 12 months (range -0.2 to 0.3;p=0.276). BCVA had improved at least three Snellen lines in 1 eye (16.7%) at the last visit. Median OCT-measured CFT change was -106 µm at 1 month (range -24 to -178;p=0.043), -106.5 µm at 3 months (range -24 to -206;p=0.043), -103 µm at 6 months (range -45 to -443;p=0.043), -107 µm at 9 months (range -71 to -347;p=0.043), and -202 µm at 12 months (range -94 to -236;p=0.068). Two eyes required filtrating surgery due to uncontrolled glaucoma. A third eye developed ocular hypertension, which was controlled with topical hypotensive medication.
Conlusions
Intravitreal injection of the fluocinolone acetonide implant (Iluvien) provided sustained anatomic improvement of refractory inflammatory macular oedema during the first year after injection. BCVA was stabilized for at least 12 months after the injection in most patients. One in 3 patients required filtrating glaucoma surgery due to uncontrolled glaucoma after the surgery.
Financial Disclosure
Esther CIANCAS has received honoraria from Brill Pharma. Julio J GONZALEZ-LOPEZ has received study grants from Allergan, Brill Pharma, Novartis and Thèa.
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