Management of Patients with Diabetic Macular Edema Switched from Dexamethasone Intravitreal Implant to Fluocinolone Acetonide Intravitreal Implant

Abstract

To assess anatomical and functional outcomes after switching from dexamethasone implant (DEXi) to fluocinolone acetonide implant (FAci) in 113 diabetic macular edema eyes, a multicentric retrospective observational study was conducted. Seventy-five eyes (73.5%) were switched 1–8 weeks after their last DEXi. The mean best-corrected visual acuity improved to 59.8 letters at month 4 and remained stable during the follow-up. The mean central macular thickness (CMT) significantly decreased during the follow-up, with a minimum of 320.9 μm at month 3. The baseline CMT was higher in eyes that received the last DEXi >8 weeks versus <8 weeks before the first FAci (p < 0.021). After FAci injection, additional treatments were needed in 37 (32.7%) eyes. A longer diabetes duration (p = 0.009), a longer time between the last DEXi and the first FAci (p = 0.035), and a high baseline CMT (p = 0.003) were risk factors for additional treatments. The mean intraocular pressure was <19 mmHg at all timepoints, with no difference between eyes receiving the last DEXi ≤8 weeks or >8 weeks before the switch. Switching from DEXi to FAci in DME is effective and safe. A short time between the last DEXi and the first FAci reduced CMT fluctuations and the need for early additional treatments.

The Treatment of Diabetic Retinal Edema with Intravitreal Steroids: How and When

“…The clinical efficacy of the Iluvien intravitreal insert has been demonstrated by other RCTs and several real-life observational studies [ 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 ] and confirmed by systematic reviews, meta-analyses, and expert panels [ 142 , 143 , 144 ].…”

“…Published studies with the FAc implant with at least 36 months of follow-up reported a VA gain ranging between 3.6 and 11 letters [ 40 , 85 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 ].…”

“…In real-world observational studies, the percentages of IOP-related side effects attributable to Iluvien appeared significantly lower than those reported by the FAME pivotal study [ 85 ]. Iluvien intravitreal implant was associated with a mean risk of post-operative IOP elevation of 20%, depending on the different definitions of IOP rise, with a risk of steroid-induced glaucoma of 0–10% [ 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 149 ] and a mean requirement of glaucoma surgeries of 0.6%, ranging from 0% to 4.3% [ 142 , 143 ], whereas a minority of cases should receive glaucoma surgery, including trabeculectomy, shunts implant, and minimally invasive glaucoma surgery [ 148 ].…”

“…This discrepancy between clinical trials and real-world data can be explained considering that, in clinical practice, almost only patients previously treated with intravitreal steroids without post-operative IOP elevation were selected [ 136 , 137 , 139 , 141 ].…”

Efficacity and Safety of the Fluocinolone Acetonide Implant in Uveitic Macular Edema: A Real-Life Study from the French Uveitis Network

“…In this cohort, patients received FAi after a mean time of 5 months after the latest DEXi, which is longer than the 4- to 8-week interval that the French Uveitis Network currently recommends (data not published). In fact, it has been shown elsewhere that the best functional and anatomical results are reached faster in patients injected with FAi at the time of DEXi peak of action (i.e., around 4–8 weeks) [ 27 , 28 ].…”