Fluocinolone acetonide for the treatment of diabetic macular edema

ABSTRACT

In addition to VEGF inhibitors such as ranibizumab, aflibercept or bevacizumab, clinical and experimental investigations have revealed the great potential of steroids in the treatment of DME. At present two intravitreal steroid inserts are approved for the treatment of DME containing either dexamethasone or fluocinolone acetat (FA) as a pharmacological compound. The non degradable intravitreal FA insert releases 0.2 µg FA per day (Iluvien, Alimera Sciences). Clinical phase III studies have demonstrated the beneficial effect of the FA insert to last up to three years, especially in patients with a prolonged history of DME of at least three years at the initiation of therapy. While the treatment appears to be well tolerated over all, side effects such as cataract formation in nearly all treated phakic patients and raise of intraocular pressure need to be discussed with the patients as potential complications of the treatment.

KEYWORDS:

• Diabetic macular edema
• fluocinolone acetonide
• visual acuity
• macular thickness

Financial & competing interests disclosure

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Diabetic macular edema is a sight threatening condition.

• Laser photocoagulation is the gold standard for macular edema not involving the fovea.

• Macular edema with foveal involvement is as a first line treated with vascular endothelial growth factor (VEGF) inhibitors.

• Fluocinolone acetonide represents an effective second-line treatment in cases that did not respond to anti-VEGF therapy.

• Cataract formation and increase of intraocular pressure are complications following the intravitreal injection of an fluocinolone insert and need to be considered when the treatment is discussed with the patient