1
|
Teixeira C, Pessoa B, Ruão M, Sousa JPC, Penas S, Silva R, Carneiro Â, Meireles A. ILUVIEN ® in diabetic macular edema that persists or recurs despite treatment: Results from the Retina.pt ® RIVER audit. Eur J Ophthalmol 2024; 34:1149-1158. [PMID: 38013451 DOI: 10.1177/11206721231217525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
PURPOSE Persistent diabetic macular edema (DME) remains a problem in clinical practice, with many patients having a suboptimal response to the standard of care (SOC). Evidence supports the long-term efficacy of intravitreal fluocinolone acetonide (FAc) implant (ILUVIEN®) in patients that have responded sub-optimally, although there is still scarce data from real-world Portuguese practices. We aimed to monitor the current SOC in selected Portuguese practices prior to FAc implantation and then assess the long-term effectiveness and safety of the FAc implant. SETTINGS The study included patient data from five Portuguese public hospitals. DESIGN This was a non-interventional, multicenter audit of data collected from Retina.pt registry from patients with persistent or recurrent DME despite treatment. METHODS Outcome measures included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP). Results were compared at regular times over 36 months. RESULTS This study included 222 eyes from 152 patients. A significant decrease in BCVA (P < 0.001) and a significant increase in CMT (P = 0.013) were observed prior to FAc. A significant increase in BCVA was registered at 6 months after FAc implant administration (P < 0.001), which was maintained during follow-up. No relevant changes in IOP were observed. Treatment burden was reduced as a result of treatment with FAc (P < 0.001 for anti-VEGF, corticosteroids, or both treatments) in the full population. CONCLUSIONS In Portuguese practice, data showed that pre-FAc implantation, some patients did not respond to SOC treatment and/or they were undertreated. Following FAc implant administration, there were rapid, sustained, long-term visual and anatomical improvements, and a marked reduction in treatment burden.
Collapse
Affiliation(s)
- Carla Teixeira
- Department of Ophthalmology of Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Porto, Portugal
| | - Bernardete Pessoa
- Diabetes Ocular Department of Centro Hospitalar e Universitário de Santo António (CHUdSA), Porto, Portugal
- Department of Ophthalmology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute for the Biomedical Sciences Abel Salazar from University of Porto (UMIB ICBAS - UP), Porto, Portugal
| | - Miguel Ruão
- Department of Ophthalmology of Centro Hospitalar entre Douro e Vouga, Santa Maria da Feira, Portugal
| | | | - Susana Penas
- Department of Ophthalmology of Centro Hospitalar Universitário de São João (CHUSJ), E.P.E., Porto, Portugal
- Department of Ophthalmology of Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rufino Silva
- Department of Ophthalmology, Ophthalmology Clinic, Faculty of Medicine of the University of Coimbra (FMUC), Coimbra, Portugal
- Department of Ophthalmology of Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Department of Ophthalmology, Coimbra, Centro Académico Clínico de Coimbra (CACC), Coimbra, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology of Centro Hospitalar Universitário de São João (CHUSJ), E.P.E., Porto, Portugal
| | - Angelina Meireles
- Department of Ophthalmology of Centro Hospitalar e Universitário de Santo António (CHUdSA), Porto, Portugal
| |
Collapse
|
2
|
Soares RM, Ferreira CC, Fernandes JDS, Madeira C, Silva LMA, Saraiva E, Ribeiro L, Fonseca S. Real-World Evidence of the Long-Term Effectiveness of 0.2 μg/Day Fluocinolone Acetonide Implant in Persistent and Recurrent Diabetic Macular Edema - A Single Center Study. Clin Ophthalmol 2024; 18:1057-1066. [PMID: 38646183 PMCID: PMC11032137 DOI: 10.2147/opth.s382920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/15/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose To report the long-term functional, anatomical and safety outcomes of 0.2 μg/day fluocinolone acetonide 0.19mg in patients with persistent or recurrent diabetic macular edema (DME). Methods Retrospective, observational, single-center study of patients with recurrent or persistent DME. All patients received 0.2 μg/day of fluocinolone acetonide 0.19mg, and data were collected at baseline and months 1, 3, 6, 12, 24 and 36 after implantation. Outcomes measured included best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and safety outcomes. Results A total of 28 eyes from 28 patients were included. The mean age was 66.5 years (95% CI 62.8-70.2) with a mean duration of DME of 8.8 years (95% CI 7.7-10.0). Only two eyes were phakic. Mean follow-up was 25.4 months (95% CI 21.2-29.6). Mean BCVA at baseline was 48.6 ETDRS letters (95% CI 41.3-55.8) and improved as early as month 1 of follow-up with a mean gain in BCVA of 7.8 (95% CI 4.3-11.3) ETDRS letters (p<0.001). Statistically significant improvements in BCVA were also observed at months 6, 12 and 24. At baseline, patients had a mean CMT of 530.5µm (95% CI 463.0-598.0), and a decrease in CMT was observed, starting at the first month of follow-up (mean CMT reduction of -170.5µm, 95% CI -223.8- -117.1; p<0.001). Statistically significant decreases in CMT were also observed at months 6, 12, 24, and 36, with the maximum decrease observed at month 12 (p<0.001). Mean IOP at baseline was 16.4mmHg (95% CI 15.3-17.5) and nine eyes (32.1%) had an IOP ≥21mmHg during follow-up. Conclusion Our results support the effectiveness and safety profile of fluocinolone acetonide. Although additional long-term real-world evidence is required, fluocinolone acetonide may represent a safe strategy for daily, low-dose, sustained and localized release to the posterior segment of the eye, providing both functional and anatomical benefits in DME.
Collapse
Affiliation(s)
- Ricardo Machado Soares
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| | - Catarina Cunha Ferreira
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| | | | - Carolina Madeira
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| | - Luís M A Silva
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| | - Eduardo Saraiva
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| | - Lígia Ribeiro
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| | - Sofia Fonseca
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| |
Collapse
|
3
|
Reich S, Lopez M, Leff J, Herman J. DEXTENZA versus Topical Steroid or Antihistamine Therapy for Treatment of Allergic Conjunctivitis. Clin Ophthalmol 2024; 18:473-480. [PMID: 38375441 PMCID: PMC10875166 DOI: 10.2147/opth.s440840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose To compare clinical outcomes and patient preference for the dexamethasone intracanalicular insert (DEX) versus topical loteprednol (LOT) or olopatadine (OLO) for the treatment of allergic conjunctivitis in a real-world model of allergen exposure. Methods This was a prospective comparative trial. Adults with testing-confirmed bilateral allergic conjunctivitis received DEX in the more symptomatic eye and either LOT 2 times daily or OLO once daily for 30 days in the fellow eye. The primary outcome was patient preference for treatment. Clinical outcomes included ocular itching and hyperemia, lid swelling, and watering/tearing. Safety outcomes included intraocular pressure (IOP). Results Thirty patients participated and completed the study. All received DEX in the eye with worse symptoms and 15 received LOT and the other 15 received OLO in the other eye. Patients preferred DEX (10/15; 66.7%) over LOT (4/15; 26.7%), with one patient having no preference (p = 0.0103). Patients had no preference between DEX (8/15; 53.3%) and OLO (6/15; 40%), with one patient having no preference (p = 0.1044). In the DEX/LOT cohort, ocular itching and hyperemia improved more with DEX than LOT (p ≤ 0.009), while in the DEX/OLO cohort, the DEX eyes showed greater improvement in conjunctival hyperemia (p < 0.0001) but not itching (p = 0.074). No between-group differences were seen in eyelid swelling or tearing/watering in either cohort. Mean change in IOP was similar between the DEX and LOT eyes (p = 0.4921), and mean IOP rose more in the DEX eyes than the OLO eyes (by <1 mmHg; p = 0.0403). Conclusion Overall, this real-world study demonstrated that the dexamethasone intracanalicular insert was as effective as a topical antihistamine/mast cell stabilizer and more effective than topical steroids in relieving the signs and symptoms of allergic conjunctivitis. This insert should be considered as an alternative to topical therapy for the treatment of allergic conjunctivitis.
Collapse
Affiliation(s)
- Shani Reich
- Clinical Research Center of Florida, Pompano Beach, FL, USA
| | - Maria Lopez
- New England Eye Center/Tufts Medical Center, Boston, MA, USA
| | - Jacqueline Leff
- Touro Osteopathic School of Medicine, Touro University, New York, NY, USA
| | - Jordan Herman
- Clinical Research Center of Florida, Pompano Beach, FL, USA
| |
Collapse
|
4
|
Rousseau N, Lebreton O, Masse H, Maucourant Y, Pipelart V, Clement M, Le Lez ML, Khanna RK, Pepin M, Eude Y, Le Meur G, Weber M, Ducloyer JB. Fluocinolone Acetonide Implant Injected 1 Month after Dexamethasone Implant for Diabetic Macular Oedema: the ILUVI1MOIS Study. Ophthalmol Ther 2023; 12:2781-2792. [PMID: 37369907 PMCID: PMC10441852 DOI: 10.1007/s40123-023-00749-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION The aim of this study was to assess the efficacy and safety of fluocinolone acetonide implant (FAci) injected 1 month after the last dexamethasone intravitreal implant (DEXi) in chronic diabetic macular oedema (DME) patients. METHODS Retrospective multicentric study conducted in pseudophakic patients with chronic DME frequently treated with dexamethasone intravitreal implant (DEXi; time to DME recurrence ≤ 6 months), receiving FAci 1 month after the last DEXi, with at least a 6-month follow-up. Best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography, intraocular pressure (IOP) and additional treatments were assessed on the day of FAci injection (M0), 1 (M1) and 3 months (M3) later and then every 3 months. RESULTS A total of 41 eyes from 34 patients were included. At M0, patients' mean age was 68.7 ± 9.8 years, the mean DME duration was 63.9 ± 22.9 months, the mean interval between two DEXi was 14.2 ± 3.3 weeks. M12 data were available for 71% of patients. At baseline, the mean BCVA, CMT and IOP were 63.2 ± 16.6 letters, 299.4 ± 103.3 µm, and 16.2 ± 4.5 mmHg, respectively, and remained stable during the follow-up. At M12, 14% of patients required additional intravitreal treatments. CONCLUSION In pseudophakic patients with chronic DME showing good response to DEXi but requiring repeated injections every < 6 months, switching to FAci 1 month after the last DEXi was effective and safe. Further prospective randomized controlled studies are needed to confirm these findings, and to determine the best interval between the last DEXi and the first FAci.
Collapse
Affiliation(s)
- Nicolas Rousseau
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Olivier Lebreton
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Hélène Masse
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Yann Maucourant
- Centre Hospitalier Universitaire de Rennes, Service d'ophtalmologie, Rennes, France
| | - Valentin Pipelart
- Centre Hospitalier Le Mans, Service d'ophtalmologie, Le Mans, France
| | - Manon Clement
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Marie-Laure Le Lez
- Hôpital Universitaire Bretonneau, Service d'ophtalmologie, Tours, France
| | - Raoul Kanav Khanna
- Hôpital Universitaire Bretonneau, Service d'ophtalmologie, UMR 1253, iBrain, Tours, France
| | - Maxime Pepin
- Centre Hospitalier Universitaire d'Angers, Service d'ophtalmologie, Angers, France
| | - Yannick Eude
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Guylène Le Meur
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Michel Weber
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Jean-Baptiste Ducloyer
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France.
| |
Collapse
|
5
|
Dot C, Poli M, Aptel F, Labbe A, Kodjikian L, Baillif S, Bodaghi B, Denis P. Ocular hypertension and intravitreal steroids injections, update in 2023. French guidelines of the French glaucoma society and the French ophthalmology society. J Fr Ophtalmol 2023; 46:e249-e256. [PMID: 37302867 DOI: 10.1016/j.jfo.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
These guidelines are a consensus of French glaucoma and retina experts on the management of ocular hypertension (OHT) observed in a third of the cases after corticosteroid implant intravitreal injections. They update the first guidelines published in 2017. Two implants are marketed in France: the dexamethasone implant (DEXi) and the fluocinolone acetonide implant (FAci). It is essential to assess the pressure status before injecting a patient with a corticosteroid implant. A molecule-specific monitoring of the intraocular pressure is needed throughout the follow-up and at the time of reinjections. Real-life studies have allowed optimizing the management algorithm by significantly increasing the safety of these implants. Corticosteroid testing with DEXi should be performed before switching to FAci to optimize pressure tolerance of FAci. Beyond topical hypotensive treatments, selective laser trabeculoplasty may be considered in the therapeutic arsenal for the management of steroid-induced OHT and subsequent injections.
Collapse
Affiliation(s)
- C Dot
- HIA Desgenettes/CHU E. Herriot, Lyon, France.
| | - M Poli
- Pôle vision, Ecully, France
| | | | - A Labbe
- CHNO des XV-XX, Paris, France
| | | | | | - B Bodaghi
- CHU de Pitié Salpétrière, Paris, France
| | - P Denis
- CHU de Croix-Rousse, Lyon, France
| |
Collapse
|
6
|
Dot C, Poli M, Aptel F, Labbe A, Kodjikian L, Baillif S, Bodaghi B, Denis P. [Intraocular pressure elevation and intravitreal steroid implant injection: State of the art in 2023. Recommendations of the French Glaucoma Society and French Ophthalmology Society [French version]]. J Fr Ophtalmol 2023; 46:803-810. [PMID: 37481449 DOI: 10.1016/j.jfo.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 07/24/2023]
Abstract
These are the recommendations of French glaucoma and retina experts on the management of ocular hypertension (OHT) observed in 1/3 of cases after intravitreal steroid implant injections. They are an update to the recommendations first published in 2017. There are two implants on the French market: the dexamethasone (DEXi) and fluocinolone acetonide (FAci) implants. It is important to know the pressure status before injecting a patient with a steroid implant. Monitoring of the IOP adapted to the specific drug is necessary throughout follow-up and reinjections. Real-life studies have made it possible to optimize the management algorithm by significantly increasing the safety of use of these implants. A corticosteroid test with DEXi is necessary before switching to FAci to optimize the pressure tolerance of the latter. In addition to topical glaucoma medications, SLT laser can be considered in the therapeutic arsenal for the management of steroid-induced OHT and future injections.
Collapse
Affiliation(s)
- C Dot
- HIA Desgenettes, CHU É.-Herriot, Lyon, France.
| | - M Poli
- Pôle vision, Écully, France
| | | | - A Labbe
- CHNO des XV-XX, Paris, France
| | | | | | - B Bodaghi
- CHU Pitié-Salpêtrière, Paris, France
| | - P Denis
- CHU Croix-Rousse, Lyon, France
| |
Collapse
|
7
|
Al Qassimi N, Kozak I, Al Karam M, Neri P, Aduriz-Lorenzo PM, Attawan A, Awadalla M, El Khashab A, Abdul-Nabi M, Safar A, Al Shamsi H, Rao P, Rao M, Farid A, Gurbaxani A. Management of Diabetic Macular Edema: Guidelines from the Emirates Society of Ophthalmology. Ophthalmol Ther 2022; 11:1937-1950. [PMID: 35896888 PMCID: PMC9437198 DOI: 10.1007/s40123-022-00547-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022] Open
Abstract
In the United Arab Emirates, retinopathy has been shown to be present in 19% of the diabetic population, with diabetes identified in up to 40% of individuals aged over 55 years. Despite the prevalence of diabetic retinal diseases, there are no unified national guidelines on the management of diabetic macular edema (DME). These published guidelines are based on evidence taken from the literature and published trials of therapies, and consensus opinion of a representative expert panel with an interest in this condition, convened by the Emirates Society of Ophthalmology. The aim is to provide evidence-based, clinical guidance for the best management of different aspects of DME, with a special focus on vision-threatening diabetic retinopathy. Treatment should be initiated in patients with best-corrected visual acuity 20/30 or worse, and/or features of DME as seen on optical coherence tomography (OCT) with central retinal thickness (CRT) of at least 300 μm or in symptomatic patients with vision better than 20/25, and/or CRT less than 300 μm where there are OCT features consistent with center-involving macular edema. The treatment of DME is effective irrespective of glycated hemoglobin (HbA1c) level, and treatment must not be denied or delayed in order to optimize systemic parameters. All ophthalmic treatment options should be discussed with the patient for better compliance and expectations. Non-center-involving DME can be initially observed until progression toward the center is documented. Macular laser no longer has a primary role in center-involving DME, and anti-vascular endothelial growth factor (anti-VEGF) therapy should be considered as first-line treatment for all patients, unless contraindicated. If anti-VEGF is contraindicated, a steroid dexamethasone implant can be considered for first-line treatment. Recommendations for the treatment of DME in special circumstances and in relapsing and refractory DME are also discussed.
Collapse
Affiliation(s)
| | - Igor Kozak
- Moorfields Eye Hospital, Abu Dhabi, United Arab Emirates
| | | | - Piergiorgio Neri
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Khalifa University, Abu Dhabi, United Arab Emirates
| | | | | | | | | | - Mohamed Abdul-Nabi
- Sheikh Shakhbout Medical City in Association With Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Ammar Safar
- Moorfields Eye Hospital, Dubai, United Arab Emirates
| | | | - Prasan Rao
- Medcare Eye Centre, Dubai, United Arab Emirates
| | - Madhav Rao
- Burjeel Hospital, Abu Dhabi, United Arab Emirates
| | - Amr Farid
- Magrabi Eye Hospital, Dubai, United Arab Emirates
| | | |
Collapse
|
8
|
Lebrize S, Arnould L, Bourredjem A, Busch C, Rehak M, Massin P, Barbosa-Breda J, Lupidi M, Mariotti C, Hamza M, Grise-Dulac A, Gabrielle PH, Baillif S, Creuzot-Garcher C. Intraocular Pressure Changes After Intravitreal Fluocinolone Acetonide Implant: Results from Four European Countries. Ophthalmol Ther 2022; 11:1217-1229. [PMID: 35426623 PMCID: PMC9114211 DOI: 10.1007/s40123-022-00504-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/21/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The 0.19 mg fluocinolone acetonide (FAc) intravitreal implant delivers a continuous intravitreal corticosteroid dose for the treatment of refractory diabetic macular oedema (DMO). The aim of this study was to assess the impact of an FAc intravitreal implant on intraocular pressure (IOP). METHODS We retrospectively collected anonymised data on the patients' characteristics, DMO treatment, and IOP and IOP-lowering treatments before and after the FAc intravitreal implant between September 2013 and March 2020 in several European centres. RESULTS A total of 221 eyes from 179 patients were included. The mean follow-up duration was 13.4 (± 12.5, range 2.4-33.5) months. Overall, 194 eyes (88.2%) had received an intravitreal dexamethasone injection before the FAc intravitreal implant. For 25 eyes (11.3%) there was a history of glaucoma, and 52 eyes (23.5%) had previous IOP-lowering treatment. Mean IOP before injection was 14.7 (3.4) mmHg and increased to 16.9 (3.7) mmHg 12 months after injection (P < 0.0001). During follow-up, 55 eyes (24.9%) required the addition or initiation of topical IOP-lowering medication, only one patient (0.5%) had laser trabeculoplasty and one patient (0.5%) a minimally invasive glaucoma surgery, and no patient required incisional IOP-lowering surgery. CONCLUSION The FAc intravitreal implant led to substantial IOP elevation. This elevation was monitored most of the time with addition or initiation of topical IOP-lowering medication.
Collapse
Affiliation(s)
- Sarah Lebrize
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Gaffarel, 21000, Dijon, France
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Gaffarel, 21000, Dijon, France
| | | | - Catharina Busch
- Department of Ophthalmology, University Hospital, Leipzig, Germany
| | - Matus Rehak
- Department of Ophthalmology, University Hospital, Leipzig, Germany
| | | | - Joao Barbosa-Breda
- Department of Ophthalmology, São João University Hospital, Porto, Portugal
- Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal
- Research Group Ophthalmology, Department of Neurosciences, KULeuven, Leuven, Belgium
| | - Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Cesare Mariotti
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Mahmoud Hamza
- Department of Ophthalmology, Le Raincy-Montfermeil Hospital, Montfermeil, France
| | - Alice Grise-Dulac
- Department of Ophthalmology, Fondation A. de Rothschild, Paris, France
| | - Pierre-Henry Gabrielle
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Gaffarel, 21000, Dijon, France
| | | | | |
Collapse
|
9
|
Extended real-world experience with the ILUVIEN® (fluocinolone acetonide) implant in the United Kingdom: 3-year results from the Medisoft® audit study. Eye (Lond) 2022; 36:1012-1018. [PMID: 33972705 PMCID: PMC8107780 DOI: 10.1038/s41433-021-01542-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/24/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aimed to assess the long-term effectiveness of the 0.2 μg/day fluocinolone acetonide (FAc) implant over ≥3 years for patients with diabetic macular oedema. METHODS A retrospective audit of pseudo-anonymised data from patients with chronic diabetic macular oedema (cDMO) and treated with the FAc implant across 14 UK clinical sites. Safety and clinical effectiveness were measured. RESULTS Two-hundred and fifty-six eyes had ≥3 years of follow-up (mean 4.28 years), during which a mean of 1.14 FAc implants were used per eye. Mean best-recorded visual acuity (BRVA) increased from 52.6 to 56.7 letters at month 3 and remained stable thereafter; this trend was also seen in pseudophakic eyes. The proportion of patients attaining a BRVA ≥6/12 increased from 17% at baseline to 27% 1 month after FAc implant and remained stable above 30% from month 12 onwards. Eyes with no prior history of intraocular pressure (IOP)-related events required significantly less treatment-emergent IOP-lowering medication than those with a prior history of IOP events (17.9% vs. 50.0% of eyes; p < 0.001). The incidence of an IOP increase of ≥10 mmHg, use of IOP-lowering medication, laser trabeculoplasty and IOP-lowering surgery was 28.9%, 29.7%, 0.8% and 2.7%, respectively, for the whole cohort. There were significant reductions in mean central foveal thickness and macular volume (p < 0.001). CONCLUSIONS The FAc implant was well tolerated, with predictable and manageable IOP-related events while delivering a continuous microdose of corticosteroid to eyes with cDMO, providing prolonged vision preservation and a reduced number of treatments.
Collapse
|