The efficacy and safety outcomes of the 0.19 mg fluocinolone acetonide implant after prior treatment with the 0.7 mg dexamethasone implant in patients with diabetic macular edema

Abstract

Purpose: There are little or no published data comparing the outcomes of ILUVIEN^® (0.19 mg fluocinolone acetonide [FAc]) and OZURDEX^® (0.7 mg dexamethasone [DEX]) implants in patients with diabetic macular edema (DME), and this case sought to compare their outcomes.

Methods: This case was extracted from a monocentric audit involving a pool of 25 patients (33 eyes) with DME and treated with a single FAc implant between October 2013 and December 2016. This case, a 61-year-old male with a pseudophakic lens, is from a patient that had received 4 intravitreal injections of a DEX implant prior to FAc implant and then was monitored for 3 years until re-treatment with a second FAc implant. Parameters measured included visual acuity (VA), central retinal thickness (CRT), and intraocular pressure (IOP).

Results: After the DEX implants, CRT transiently improved. In March 2014, the decision was taken to administer an FAc implant, and this led to a reduction in CRT below 300 µm (from a baseline of 748 µm), and this was sustained for 30 months. VA remained above 65 Early Treatment Diabetic Retinopathy Study letters to month 36, after which time a second FAc implant (in April 2017) was administered due to recurrence of edema and CRT decreased to below 300 µm and VA improved to 70 letters. Side effects included elevated IOP, which was effectively managed with IOP-lowering drops.

Conclusion: A single injection of FAc implant led to sustained improvements in CRT and VA that lasted for between 30 and 36 months, which is in contrast to the DEX implant where re-treatment was generally required within 6-7 months. After 36 months, re-treatment with the FAc implant again led to improved VA and CRT, and responses that were similar to those achieved with the first FAc implant.

Keywords: diabetic macular edema; fluocinolone acetonide; microdosing.

Figure 1

VA and CRT over time following treatment with repeated injections of the DEX (n=4) and FAc implant (n=2). Notes: Intravitreal injections of DEX and FAc implants are shown in green and blue, respectively. The patient was re-treated with a second FAc implant in April 2017. Abbreviations: CRT, central retinal thickness; DEX, dexamethasone; ETDRS, Early Treatment Diabetic Retinopathy Study; FAc, fluocinolone acetonide; OCT, optical coherence tomography; VA, visual acuity.