TY - JOUR
T1 - The outcome of fluocinolone acetonide intravitreal implant is predicted by the response to dexamethasone implant in diabetic macular oedema
AU - On behalf of the International Retina Collaborative
AU - Cicinelli, Maria Vittoria
AU - Rosenblatt, Amir
AU - Grosso, Domenico
AU - Zollet, Piero
AU - Capone, Luigi
AU - Rabiolo, Alessandro
AU - Lattanzio, Rosangela
AU - Loewenstein, Anat
AU - Bandello, Francesco
AU - Nassisi, Marco
AU - Tan, Anna
AU - Reynolds, Rhianon
AU - Singh, Sumit Randhir
AU - Vaezi, Kaivon P.
AU - Giocanti-Aurégan, Audrey
AU - Weinberg, Tamir
AU - Faes, Livia
AU - Schwartz, Roy
AU - Reyes, Denis Yurani Anaya
AU - Savastano, Alfonso
AU - Touhami, Sara
AU - Garcia, Humberto Ruiz
AU - Pohlmann, Dominika
AU - Plant, Adam
AU - Ventura, Camila V.
AU - Chatziralli, Irini
AU - Phasukkijwatana, Nopasak
AU - Ruiz-Medrano, Jorge
AU - Yuan, Miner
AU - Yılmaz, İhsan
AU - Vogt, Denise
AU - Ting, Daniel Shu Wei
AU - Mustapha, Mushawiahti
AU - Mendaro, Marcos
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.
PY - 2021/12
Y1 - 2021/12
N2 - Background/Objectives: To investigate if the visual and anatomic response to the first dexamethasone implant (DEX) predicts the 12-month clinical outcome after shifting to fluocinolone acetonide (FAc) implant in patients with diabetic macular oedema (DMO). Methods: Retrospective cohort study including pseudophakic patients with previously treated DMO, undergone one or more DEX injections before FAc. Functional and morphologic response to DEX was defined based on the best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes after the first DEX, respectively. Steroid-response was defined as intraocular pressure (IOP) elevation ≥5 mmHg or IOP > 21 mmHg after any previous DEX exposure. Pairwise comparisons for BCVA, CMT, and IOP after FAc were performed with linear mixed models and a repeated-measure design. Results: Forty-four eyes of 33 patients were included. Patients were shifted to FAc after a mean ± standard deviation of 4.6 ± 3.2 DEX injections. Overall, BCVA and CMT improved during the first 12 months after switching to FAc (p = 0.04 and p < 0.001, respectively). Only eyes with a good morphologic response to DEX had a significant CMT reduction after FAc (p < 0.001), while no significant relationship was found between BCVA improvement after DEX and after FAc. IOP elevation occurred in 9 eyes (20%) following DEX implant. These eyes carried a 20-fold increased risk of having an IOP rise after FAc (p < 0.001), with a non-linear relationship between the IOP increase after DEX and the one after FAc. Conclusion: The response to previous DEX may anticipate the morphologic response to subsequent FAc. Eyes with steroid-induced IOP elevation after DEX are at a high risk of IOP increase after FAc. The visual response after FAc was not associated with the visual response to previous steroids, indicating that FAc may have a role also in patients refractory to DEX implant.
AB - Background/Objectives: To investigate if the visual and anatomic response to the first dexamethasone implant (DEX) predicts the 12-month clinical outcome after shifting to fluocinolone acetonide (FAc) implant in patients with diabetic macular oedema (DMO). Methods: Retrospective cohort study including pseudophakic patients with previously treated DMO, undergone one or more DEX injections before FAc. Functional and morphologic response to DEX was defined based on the best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes after the first DEX, respectively. Steroid-response was defined as intraocular pressure (IOP) elevation ≥5 mmHg or IOP > 21 mmHg after any previous DEX exposure. Pairwise comparisons for BCVA, CMT, and IOP after FAc were performed with linear mixed models and a repeated-measure design. Results: Forty-four eyes of 33 patients were included. Patients were shifted to FAc after a mean ± standard deviation of 4.6 ± 3.2 DEX injections. Overall, BCVA and CMT improved during the first 12 months after switching to FAc (p = 0.04 and p < 0.001, respectively). Only eyes with a good morphologic response to DEX had a significant CMT reduction after FAc (p < 0.001), while no significant relationship was found between BCVA improvement after DEX and after FAc. IOP elevation occurred in 9 eyes (20%) following DEX implant. These eyes carried a 20-fold increased risk of having an IOP rise after FAc (p < 0.001), with a non-linear relationship between the IOP increase after DEX and the one after FAc. Conclusion: The response to previous DEX may anticipate the morphologic response to subsequent FAc. Eyes with steroid-induced IOP elevation after DEX are at a high risk of IOP increase after FAc. The visual response after FAc was not associated with the visual response to previous steroids, indicating that FAc may have a role also in patients refractory to DEX implant.
U2 - 10.1038/s41433-020-01373-1
DO - 10.1038/s41433-020-01373-1
M3 - Article
SN - 0950-222X
VL - 35
SP - 3232
EP - 3242
JO - Eye
JF - Eye
IS - 12
ER -
