Persistent or Recurrent Diabetic Macular Edema After Fluocinolone Acetonide 0.19 mg Implant: Risk Factors and Management - 20/06/20
, Alessandro Rabiolo a, Piero Zollet a, Luigi Capone a, Rosangela Lattanzio a, Francesco Bandello a, bAbstract |
Purpose |
To investigate baseline characteristics of patients undergoing additional antivascular endothelial growth factor (VEGF) injections for residual or recurrent diabetic macular edema (DME) in the first year after 0.19-mg fluocinolone acetonide (FAc) implant.
Design |
Prospective cohort study.
Methods |
Ninety-four eyes of 66 patients received an FAc implant. Eyes with persistent or recurrent DME were managed with pro re nata anti-VEGF agents. Demographic data and medical history were collected at baseline. Best-corrected visual acuity and central macular thickness were measured every 2 months. The 3 outcomes explored were 1) the risk factors for administration of additional anti-VEGF agents, 2) the interval from FAc to first anti-VEGF injection; and 3) the number of anti-VEGF doses required to maintain regression of DME.
Results |
Eighteen eyes (19.1%) of 13 patients received 1.3 ± 0.6 anti-VEGF injections. These eyes had significantly thicker central macular thickness at baseline and over the entire follow-up period (P < .001); best-corrected visual acuity was similar at every time point to eyes that were not receiving extra DME treatments. Eyes without preexistent panretinal photocoagulation (PRP) had a higher risk to undergo supplemental treatments (hazard ratio 1.5 [95% confidence interval 1.1-2.5, P = .03). The interval between FAc implant and the first anti-VEGF had a significant linear positive relationship with the number of dexamethasone implants before FAc implant (P = .002, R2 = 0.47). No association was found between baseline factors and the number of injections given.
Conclusion |
Anti-VEGF agents are efficient treatment to maintain visual acuity in residual/recurrent DME after FAc. Patients with higher baseline central macular thickness and with no previous central macular thickness are more likely to require additional treatments to control DME.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Nearly 20% of eyes receiving fluocinolone acetonide (FAc) 0.19 mg bioerodable implant (Iluvien) for diabetic macular edema (DME) experience persistent or recurrent DME in the first year after injection. |
• | Patients with persistent or recurrent DME have significantly higher central macular thickness (CMT) at baseline and over entire follow-up. |
• | Persistent or recurrent DME can be successfully treated with intravitreal anti–vascular endothelial growth factor (VEGF) agents. |
• | The number of anti-VEGF injections administered in the first year is lower and the mean interval between consecutive anti-VEGF injections is longer than reported on anti-VEGF–only regimen. |
• | The final visual acuity at 12 months of follow-up is similar between patients who received additional anti-VEGF and those who did not receive extra treatments for persistent or recurrent DME. |
Plan
Vol 215
P. 14-24 - juillet 2020 Retour au numéro
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