Patients with advanced diabetic macular edema who do not respond sufficiently to anti-VEGF therapy, should be considered for treatment with Fluocinolone acetonide intravitreal implant (FAc), according to a study published in Touch Ophthalmology.
The global prevalence of diabetic retinopathy among individuals with diabetes is around 35 per cent, with DMO present in 6.8 per cent. Anti-VEGFs, such as ranibizumab, bevacizumab and aflibercept, successfully treat the majority of patients, however British consultant ophthalmologist Fahd Quhill said, around a third or more of patients are considered insufficiently responsive to this therapy.
Having reviewed real world data from case studies, Mr. Quhill says “intravitreal steroids, particularly in sustained-release implants, offer an alternative therapeutic strategy, providing localised delivery of the corticosteroid to maximise its anti-inflammatory, angiostatic and anti-permeability effects, as well as minimising the risks of systemic toxicity”. As well as the efficacy and safety, FAc intravitreal implants were associated with improvements in visual quality of life and the ability to perform daily routines
He reported that although the use of FAc intravitreal implants were associated with accelerated development of cataract, and elevated IOP, cases cited were managed with IOP-lowering drops.
Mr. Quhill wrote, “Clinical evidence shows that earlier treatment reduces visual loss in diabetic retinopathy. It is important to identify corticosteroid responders and anti-VEGF non-responders early in the disease course and initiate suitable treatment for each patient. Earlier therapy results in improved functional outcomes i.e. gaining 20/40 vision, which is satisfactory for most occupations and lifestyles, enabling ability to drive, ability to work and having the confidence to return to work. Treating later in the disease course will not restore visual function to this level and could thus prevent individual patients from being able to work or function normally in other areas of their lives.”