Functional and Morphological Responses to Fluocinolone Acetonide 0.19 mg in Noninfectious Uveitic Macular Edema Evaluated as the Area-Under-the-Curve

Abstract

Purpose: This study investigated the impact of baseline clinical and optical coherence tomography (OCT) factors on the response to a 0.19-mg fluocinolone acetonide (FAc) implant in patients with noninfectious uveitic macular edema evaluated by the area under the curve over 24 months. Methods: A retrospective study was conducted of eyes of patients with noninfectious uveitic macular edema undergoing FAc treatment, with follow-up from baseline to 24 months. The area under the curve (AUC) of best-corrected visual acuity (BCVA) and the central macular thickness (CMT) were calculated using the trapezoidal rule. Clinical and OCT data at the time of FAc administration were collected, and associations with AUC of BCVA and CMT changes were investigated. Results: Twenty-three patients were enrolled. BCVA and CMT significantly improved after FAc implantation (P < 0.05). AUC_BCVA and AUC_CMT were 0.41 ± 0.33 logarithm of minimal angle of resolution/6 months and 320.15 ± 321.64 μm/6 months, respectively. Better baseline BCVA (coefficient [coef.] = 0.83, P < 0.001) and macular thickness reduction after FAc administration (coef. = -0.0001, P < 0.05) were associated with better BCVA after FAc treatment. In contrast, baseline OCT biomarkers such as ellipsoid zone reflectivity and choroidal vascularity index, sex, or disease duration before FAc injection showed no correlation with AUC_BCVA and AUC_CMT (P > 0.05). The younger the patient at the time of FAc injection, the greater the reduction in CMT (coef. = 1.76, P < 0.05). Conclusions: Among all clinical and morphological baseline factors, Baseline BCVA was the strongest predictor for AUC_BCVA, while no association with baseline OCT features was observed. Overall, improvement of BCVA and CMT after FAc injection was maintained over 24 months. This study is registered in the German Clinical Trials Register under the DRKS-ID: DRKS00024399.

Keywords: drug response; fluocinolone acetonide; macular edema; ocular implant; optical coherence tomography biomarkers; uveitis.

FIG. 1.

Overview of local and systemic therapy approaches before and after FAc implantation. Notably, FAc implantation enabled reduction of local CS injections in most patients. Some patients did not need adjunct CS injections after FAc implantation for up to 2 years, that is, patients 1, 3, and 4. CS, corticosteroid; FAc, fluocinolone acetonide.

FIG. 2.

AUC_BCVA calculated using the trapezoidal rule and mean BCVA changes stratified according to baseline BCVA. (A) BCVA changes from baseline to 24 months. Measurements of each time point are plotted as a line graph and the AUC represents the summation of all trapezoidal subintervals under the plotted line (gray area). (B) Worse BCVA at baseline results in worse final visual outcome at month 24. AUC, area under the curve; BCVA, best-corrected visual acuity; logMAR, logarithm of minimal angle of resolution.

FIG. 3.

AUC_CMT calculated using the trapezoidal rule and correlation between baseline parameters and AUC_BCVA. (A) CMT changes from baseline to 24 months. Measurements of each time point are plotted as a line graph and the AUC represents the summation of all trapezoidal subintervals under the plotted line (gray area). (B) Linear correlation between baseline parameters (BCVA, CRT, CVI, and EZR) and AUC_BCVA/6 months. The regression coefficient was calculated with Spearman's rank correlation. (C) CMT at baseline correlated with AUC_CMT. CMT, central macular thickness; CRT, central retinal thickness; CVI, choroidal vascularity index; EZR, ellipsoid zone reflectivity ratio.