|Articles|March 1, 2015

Real-world experience provides clarity to intravitreal injection misconception

Using real-world experience, a retinal surgeon highlights the optimal settings for use of steroid implants for treatment of diabetic macular edema.

 

Take-home message: Using real-world experience, a retinal surgeon highlights the optimal settings for use of steroid implants for treatment of diabetic macular edema.

 

 

By Michelle Dalton, ELS; Reviewed by Andrew Moshfeghi, MD

Los Angeles-Within the past year, two sustained-release intravitreal injection implants-dexamethasone (Ozurdex, Allergan) and fluocinolone (Iluvien, Alimera Sciences)-were approved for the treatment of diabetic macular edema(DME) by the FDA.

Dexamethasone is designed to be implanted every 6 months, whereas fluocinolone is designed to be have a treatment effect for 36 months; these indications were based off results from the respective pivotal studies.

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Retina specialists, however, are finding a diminished durability effect with dexamethasone. (Fluocinolone had not yet started shipping by the end of 2014, limiting its real-world experience.)

“We don’t yet know if there is a diminished real-world durability effect with [fluocinolone], or what the best way to handle the diminished effect may be,” said Andrew Moshfeghi, MD, Los Angeles.

Physicians may opt to “touch up” patients with anti-vascular endothelial growth factor (VEGF) agents until insurance companies determine how often they will reimburse for the implant, Dr. Moshfeghi explained.

“We also have to think about the implications-if we re-implant, are we risking a higher rate of glaucoma?” he posed.

In his real-world experience, those issues have not manifested in patients who needed to be treated earlier than every 6 months with dexamethasone, Dr. Moshfeghi said, although he only has limited experience with early re-treatment.

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