Real-world experience: Case study shows maintained benefits with FAc in DME patient

Take-home message: In the case study discussed in this article, a patient who was treated for DME with a fluocinolone acetonide intravitreal implant reported improved vision-related quality of life and the ability to perform daily routines without problems. These benefits persisted 12-months after treatment.

 

By Faye Emery, Reviewed by Dr Erica Guerreiro Paulo

Early experience shows that the fluocinolone acetonide (FAc) intravitreal implant 0.19 mg (Iluvien, Alimera Sciences, Hampshire, UK) can provide effective long-term therapy that lasts up to 36 months, with one injection and with manageable side effects. Dr Erica Guerreiro Paulo, author of a recent case study published in the European Ophthalmic Review,¹ stated “It is rewarding to note that our patient reported greater vision-related quality of life and the ability to perform daily routines without problems following 0.2 µg/day FAc.”

Study details

The 62-year-old male patient, who was diagnosed with type 2 diabetes mellitus in 1992, was first treated for DME in 2004, for which he received left eye laser photocoagulation and triamcinolone injection. At this time his BCVA was 0.2 for his left eye and 0.8 for his right eye. Lost to follow-up until 2011, the patient’s BCVA had deteriorated to 0.2 in both eyes. In 2011 intravitreal anti-VEGF in the left eye gave no benefit for BCVA and given the lack of response to therapy and the long history of DMO, no further treatment was administered to the left eye at this time.

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 Prior to being treated with the FAc implant, the patient’s right eye had been treated with multiple injections of anti-VEGF and also short-acting corticosteroid. Surprisingly, anti-VEGF injections had no effect or led to a worsening of vision and central foveal thickness (CFT). In contrast, the early use of short-acting corticosteroid actually improved CFT with no change in vision. When combined with anti-VEGF there was an improvement in both CFT and vision, but subsequent anti-VEGF injections had little effect.

“In July 2013, after 3 years of being unresponsive to anti-VEGF treatment, the patient was given a 0.2 μg/day FAc implant,” explained Dr Guerreiro Paulo.

Case study: Positive DME outcomes observed with FAc implant

After only 3 weeks following the injection of the FAc implant there was a complete regression of DME and by 10 weeks CFT had decreased from 548 microns to 232 microns. This benefit was still sustained 6 months later and was accompanied by small improvements in visual acuity.

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