Clinical Ophthalmology (Jul 2020)
Clinical-Decision Criteria to Identify Recurrent Diabetic Macular Edema Patients Suitable for Fluocinolone Acetonide Implant Therapy (ILUVIEN®) and Follow-Up Considerations/Recommendations
Abstract
Alfredo Adán,1 Francisco Cabrera,2 Marta S Figueroa,3 Enrique Cervera,4 Francisco J Ascaso,5 Patricia Udaondo,6 Maximino Abraldes,7 Miguel Ángel Reyes,8 Marta Pazos,1 Bernardete Pessoa,9 Félix Armadá10 1Hospital Clínic de Barcelona, Barcelona, Spain; 2Complejo Hospitalario Universitario Insular Materno-Lnfantil de Gran Canaria, Las Palmas de Gran Canaria, Spain; 3Hospital Universitario Ramón y Cajal, Madrid, Spain; 4Hospital General Universitario de Valencia, Valencia, Spain; 5Hospital Clínico Universitario Lozano Blesa de Zaragoza, Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain; 6Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain; 7Complexo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain; 8Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain; 9Centro Hospitalar e Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal; 10Hospital Universitario La Paz, Madrid, SpainCorrespondence: Alfredo Adán Tel +34932275667Fax +34932275605Email [email protected]: Current management of diabetic macular edema (DME) predominantly involves treatment with short-acting intravitreal injections of anti-vascular endothelial growth factors (anti-VEGFs) and/or corticosteroids; however, short-acting therapies (lasting between 1 and 6 months) require frequent injections to maintain efficacy, meaning a considerable treatment burden for diabetic patients with multiple comorbidities. Continuous injections needed in some cases are an economic burden for patients/healthcare system, so real-life clinical practice tends to adopt a reactive approach, ie, watch and wait for worsening symptoms, which consequently increases the risk of undertreatment and edema recurrence. On March 7th 2019, a group of experts in retinal medicine and surgery held a roundtable meeting in Madrid, Spain to discuss how to (1) optimize clinical outcomes through earlier use of fluocinolone acetonide (FAc) implant (ILUVIEN®) in patients with persistent or recurrent DME despite therapy; and, (2) to provide guidance to assist physicians in deciding which patients should be treated with ILUVIEN. In this regard, a 36-month follow-up consensus protocol is presented. In conclusion, patients that achieve a complete or partial anatomical, and preferably functional, response following one or two intravitreal dexamethasone implants, but with recurrence of edema after 3– 4 months, are deemed by the authors most likely to benefit from ILUVIEN, and the switch to FAc implant should not be delayed more than 12 months after the initiation of at least the first dexamethasone implant.Keywords: diabetic macular edema, DME, fluocinolone acetonide implant therapy, ILUVIEN
