Fluocinolone acetonide (Iluvien) extended-release intravitreal implant for diabetic macular edema

Abstract

Fluocinolone acetonide (FAc) is a corticosteroid used in the FAc implant, a novel drug-delivery device currently approved in Europe but not yet approved in the USA. The drug delivery system for FAc implant allows a sustained delivery in a more posterior location in the eye and can be delivered in an outpatient setting. It has been shown to reduce diabetic macular edema via multiple mechanisms including the VEGF pathway. This allows for a more complete resolution in foveal thickness and leakage on fluorescein angiography, which increases best corrected visual acuity. Side effects, such as cataract and increased intraocular pressure, are common for ocular steroids.

Keywords::

• anti-VEGF
• diabetic macular edema
• fluocinolone acetonide
• iluvien
• intravitreal implant
• steroid

Financial & competing interests disclosure

DS Boyer is on the scientific advisory board for Alimera Sciences, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Corticosteroids work to treat diabetic macular edema through many different pathways, including, but not limited to the VEGF pathway and gene regulation.

• Side effects of CS include increased IOP and cataract formation – both of which are manageable but may require a surgical intervention.

• Fluocinolone acetonide implant is a potent CS, which has a sustained drug delivery device that allows for the drug to be placed in the vitreous (further from the anterior chamber and the lens than previous devices) to decrease the side effect profile of the drug.

• Fluocinolone acetonide implant is effective in treating some diabetic macular edema that is resistant to current treatment methods (including decreasing foveal thickness and leakage on FA).