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The Outcomes of Switching from Short- to Long-Term Intravitreal Corticosteroid Implant Therapy in Patients with Diabetic Macular Edema

2019; Karger Publishers; Volume: 63; Issue: 2 Linguagem: Inglês

10.1159/000503036

1423-0259

Sara Vaz-Pereira, João Paulo Castro Sousa, David Martins, Joaquim Canelas, Pedro Augusto Costa Reis, António Sampaio Soares, Helena Urbano, P Kaku, João Nascimento, Carlos Marques‐Neves,

Retinal and Macular Surgery

<b><i>Background:</i></b> First-line treatment for diabetic macular edema (DME) is usually with antivascular endothelial growth factor agents, followed by intravitreal corticosteroids as a second-line treatment option. Long-term corticosteroids may offer quality of life and effectiveness benefits over short-term implants. <b><i>Objectives:</i></b> To evaluate outcomes of patients with persistent or recurrent DME who switched from a short-term (dexamethasone) to a long-term (fluocinolone acetonide, FAc) corticosteroid intravitreal implant in a real-world setting. <b><i>Methods:</i></b> This is a retrospective study in 9 Portuguese centers. An FAc intravitreal implant was administered according to product labeling. Effectiveness outcomes were mean change in visual acuity (VA; ETDRS letters), central retinal thickness (CRT; µm), and macular volume (MV; mm³). The safety outcome was mean change in intraocular pressure (IOP; mm Hg). All were analyzed at months 1 and 3, and then quarterly until month 24 after implantation. <b><i>Results:</i></b> Forty-four eyes from 36 patients were analyzed. Mean duration of DME was 3.3 ± 1.9 years, and mean follow-up was 8 months. From baseline following FAc implantation, VA increased significantly at months 1 and 6 (mean +6.82 and +13.02 letters, respectively; <i>p</i> = 0.005), and last observation carried forward (LOCF; mean +8.3 letters; <i>p</i> = 0.002). CRT improved significantly at months 1 and 6 (mean –71.81 and –170.77 µm, respectively; <i>p</i> = 0.001), and LOCF (mean –121.46 µm; <i>p</i> = 0.001). MV was consistently, but not significantly, decreased from baseline to LOCF (mean –0.69 mm³; <i>p</i> = 0.062). The mean change in IOP was –0.25 and +0.88 mm Hg at months 1 and 6, respectively (<i>p</i> = 0.268), and +1.86 mm Hg at LOCF (<i>p</i> = 0.036). Increases were controlled with topical medication in most cases. <b><i>Conclusions:</i></b> The FAc intravitreal implant is effective in patients previously treated with short-term corticosteroid implants. Thus, after a suboptimal response to antiangiogenics or a short-term corticosteroid, a single FAc implant may be considered an effective and tolerable treatment that can improve long-term outcomes for patients with sight-threatening DME.