| Abstrakt: |
Introduction/Background: Anti-vascular endothelial growth factors (anti-VEGFs) are increasingly being used as first line therapeutic agents in the treatment of diabetic macular edema (DME). However, up to 50% of these patients may have an insufficient response (ISR). Inflammatory cytokine pathways, other than VEGF, may be responsible for edema recurrence in ISR. Thus, the use of a second line, long acting steroid may be of benefit in these patients. The purpose of this study was to measure efficacy and safety early outcomes in anti-VEGF ISR patients with chronic DME treated with Fluocinolone Acetonide (FAc) 0.2 μg/day. Methods: Retrospective study of 6 consecutive patients treated with FAc 0.19 mg. Selection criteria was ISR to anti-VEGF and chronicity defined as duration of DME more than 1.5 years. Outcomes as visual acuity (VA), central retinal thickness (CRT), macular volume (MV) and intraocular pressure (IOP) were measured at baseline and 2-4 weeks after intravitreal injection. All patients included in this study, which adhered to the tenets of the Declaration of Helsinki, gave their informed consent to treatment. Results: At baseline mean VA, CRT, MV and IOP were 58 letters, 507.5 μm, 10.46 mm3 and 17 mm Hg respectively. After a short period of 2-4 weeks post intravitreal injection it was observed an improvement: mean VA was 60 letters, mean CRT was 388 μm, mean MV was 10.34 mm3. Mean IOP was 19 mm Hg. Conclusions: Treatment appears to be well tolerated. Side effects such as cataract formation and raise of IOP need to be discussed with the patients as complications of the treatment, however manageable to be treated as benefits may surpass risks. Despite being unresponsive to multiple prior therapies including laser and anti-VEGF injections, switching to FAc appeared to have accomplished treatment benefit. FAc may offer an important treatment option for patients with chronic DME refractory to other treatment options. Acknowledgements: None. [ABSTRACT FROM AUTHOR] |
