Switching to intravitreal fluocinolone acetonide implant for refractory diabetic macular edema: 12- and 24-month results.

Abstract

PURPOSE\nTo report visual and anatomical outcomes of chronic/refractory diabetic macular edema (DME) treated with intravitreal fluocinolone acetonide implant.\n\n\nSETTING\nRetrospective, one arm, multicentric study.\n\n\nMETHOD\nBetween 2013 and 2018, 27 consecutive eyes of 25 patients with chronic/refractory DME were treated with a fluocinolone acetonide intravitreal implant. Best registered visual acuity (BRVA), central retinal thickness (CRT), and Goldmann tonometry intraocular pressure (IOP) were assessed at 12 and 24\u2009months. The need for IOP lowering treatment as well as top-up therapy during the follow-up were also assessed.\n\n\nRESULTS\nThe duration of DME prior to treatment in our study was 54\u2009±\u200924\u2009months. The baseline mean BRVA of 0.7\u2009±\u20090.34 logMAR improved to 0.5\u2009±\u20090.3 (p\u2009=\u20090.01) at 12\u2009months and 0.46\u2009±\u20090.3 (p\u2009=\u20090.04) at 24\u2009months. At 12\u2009months, BRVA improved in 14 eyes (52%), stabilized in 5 eyes (20%), and decreased in 3 eyes (11%). At 24\u2009months, BRVA improved further in 6 eyes (24%), stabilized in 3 eyes (12%), and decreased in 6 eyes (24 %). Mean CRT decreased from 497\u2009±\u2009176 to 349\u2009±\u2009186\u2009μm at 12\u2009months (p\u2009=\u20090.0005) and to 267\u2009±\u2009104\u2009μm at 24\u2009months (p\u2009=\u20090.001). Only five eyes required additional treatment for DME and only three eyes required treatment for raised IOP.\n\n\nDISCUSSION\nOur results show that the visual and the anatomical improvements achieved by a single injection of a fluocinolone acetonide implant were maintained up to 24\u2009months with minimal additional therapy even in eyes with a long and heavy history; however, IOP monitoring remains essential.