Steroid Therapy in Diabetic Retinopathy and Diabetic Macular Edema

2018 ◽  
pp. 160-164
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vitreoretinal Surgery ◽  
Fluocinolone Acetonide ◽  
Intravitreal Triamcinolone ◽  
Intraocular Pressure Elevation ◽  
Risk Treatment ◽  
Therapeutic Alternatives ◽  
Endothelial Growth Factor

Diabetic macular edema (DME) is the leading cause of blindness in patients with diabetic retinopathy worldwide. Therapeutic alternatives now include focal/grid laser photocoagulation, vitreoretinal surgery, and intraocular injection of anti-angiogenic and steroid molecules. In patients with recalcitrant DME, especially in those cases when anti-vascular endothelial growth factor (VEGF) agents are contraindicated or a treatment regimen with fewer intravitreal injections is required, intravitreal administration of steroids represents a fundamental alternative. Three intravitreal corticosteroid options for DME treatment are currently available including the dexamethasone delivery system, the fluocinolone acetonide insert, and off-label intravitreal triamcinolone acetonide. All of these drugs are associated with the risk of cataract progression and intraocular pressure elevation. In patients unresponsive to anti-VEGF therapy, pseudophakic, at low risk for glaucoma, or who have significant cardiovascular risk, treatment with long-lasting intraocular steroids is suggested.

scholarly journals Three-year results from the Retro-IDEAL study: Real-world data from diabetic macular edema (DME) patients treated with ILUVIEN® (0.19 mg fluocinolone acetonide implant)

2019 ◽  
Vol 30 (2) ◽  
pp. 382-391 ◽  
Author(s):  
Albert J Augustin ◽  
Silvia Bopp ◽  
Martin Fechner ◽  
Frank Holz ◽  
Dirk Sandner ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Real World ◽  
Fluocinolone Acetonide ◽  
Vascular Endothelial ◽  
Clinical Practices ◽  
Real World Data ◽  
Intravitreal Therapy ◽  
Fluocinolone Acetonide Implant ◽  
Endothelial Growth Factor

Introduction: The Retro-IDEAL (ILUVIEN Implant for chronic DiabEtic MAcuLar edema) study is a retrospective study designed to assess real-world outcomes achieved with the ILUVIEN® (0.19 mg fluocinolone acetonide (FAc)) in patients with chronic diabetic macular edema (DME) in clinical practices in Germany. Methods: This study was conducted across 16 sites in Germany and involved 81 eyes (63 patients) with persistent or recurrent DME and a prior suboptimal response to a first-line intravitreal therapy (primarily anti-VEGF intravitreal therapies). Results: Patients were followed-up for 30.8 ± 11.3 months (mean ± standard deviation) and had a mean age of 68.0 ± 10.4 years. Best-recorded visual acuity (BRVA) improved by +5.5 letters at month 9 (P ⩽ 0.005, n=56; from a baseline of 49 letters) and this was maintained through to month 30 (P ⩽ 0.05, n = 42). There was a concurrent improvement in central macular thickness with a reduction from 502 µm at baseline to 338 µm at year 1 (P ⩽ 0.0001, n = 43). This effect was sustained to year 3 (i.e. 318 µm; P ⩽ 0.0001, n = 29). Mean intraocular pressure (IOP) remained constant between baseline and year 3 with a peak change of 1.9 mm Hg occurring at year 1. Elevated IOP was observed in a similar percentage of patients prior to (22.2% of cases) and following (27.2%) treatment with the FAc implant. In the majority of cases, these elevations were managed effectively with IOP medications. Conclusions: Despite substantial amounts of prior intravitreal treatments – primarily with anti–vascular endothelial growth factor (VEGF) drugs – this real-world study showed that sustained structural and functional improvements can last for up to 3 years with a single FAc implant.

Treatment of Eyes With Diabetic Macular Edema That Had a Suboptimal Response to Antivascular Endothelial Growth Factor Therapy: 2-mg Intravitreal Triamcinolone Acetonide vs 0.7-mg Dexamethasone Implant

2020 ◽  
Vol 4 (5) ◽  
pp. 372-376
Author(s):  
Brandon Kuley ◽  
Philip P. Storey ◽  
Maitri Pancholy ◽  
Turner D. Wibbelsman ◽  
Anthony Obeid ◽  
...  
Keyword(s):  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Triamcinolone ◽  
Treatment Groups ◽  
Antivascular Endothelial Growth Factor ◽  
Factor Therapy ◽  
Growth Factor Therapy ◽  
Endothelial Growth Factor

Purpose: This article compares 2-mg intravitreal triamcinolone (IVT) and 0.7-mg dexamethasone (DEX) implant for the treatment of diabetic macular edema in eyes that had a suboptimal response to antivascular endothelial growth factor therapy. Methods: A single-center, retrospective review was conducted of patients receiving either IVT between January 1, 2013, and January 1, 2018, or patients receiving DEX between October 1, 2015, and January 1, 2018. Visual acuity and central macular thickness (CMT) were recorded at visit of first injection and all subsequent visits. Results: Twenty-five eyes were included in the DEX group and 32 eyes were included in the IVT group. Change in vision from baseline was similar between DEX and IVT at 6-month follow-up (1.1 lines vs 2.3 lines, respectively; P = .24). Mean decrease in CMT from baseline was not different at 6-month follow-up (DEX: 120 µm vs IVT: 185 µm; P = .17). Conclusions: DEX and 2-mg IVT both achieved improvement in vision and CMT with no significant differences between treatment groups at 6-month follow-up.

Long-term Therapies for Diabetic Macular Edema

2012 ◽  
Vol 06 (04) ◽  
pp. 236 ◽  
Author(s):  
Andrew J Lotery ◽  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Safety Profile ◽  
Treatment Options ◽  
Fluocinolone Acetonide ◽  
Diabetic Patients ◽  
Sustained Drug Release ◽  
Improved Outcomes ◽  
Intravitreal Implant ◽  
Endothelial Growth Factor

Diabetic macular edema (DME) is one of the main causes of visual loss in diabetic patients. Although photocoagulation and intensive control of systemic metabolic factors have achieved improved outcomes, improvement is slow and some patients with DME continue to lose vision despite treatment. Pharmacological treatment options for DME include vascular endothelial growth factor (VEGF) antagonists such as ranibizumab, bevacizumab and pegaptanib and corticosteroids, whose multiple mechanisms of action include reduction of VEGF expression. Intravitreal delivery of these agents has shown efficacy in the treatment of DME but is associated with adverse effects including cataract progression and sustained rises in intraocular pressure. The physical characteristics and potent anti-inflammatory properties of fluocinolone acetonide (FAc) have led to its use in intravitreal implants. A number of intravitreal implants have been evaluated, of which the most effective at providing sustained drug release with an acceptable safety profile is the ILUVIEN® implant. This FAc intravitreal implant provides significant, long-lasting improvements in visual acuity for patients with chronic DME and has a manageable safety profile.

The impact of vitrectomy on outcomes achieved with 0.19 mg fluocinolone acetonide implant in patients with diabetic macular edema

2021 ◽  
pp. 112067212110147
Author(s):  
Albert J Augustin ◽  
Silvia Bopp ◽  
Martin Fechner ◽  
Frank G Holz ◽  
Dirk Sandner ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Disease Process ◽  
Fluocinolone Acetonide ◽  
Vascular Endothelial ◽  
First Line ◽  
Intravitreal Implant ◽  
Fluocinolone Acetonide Implant ◽  
Endothelial Growth Factor ◽  
The Impact

Background: There is a lack of consensus on the use of intravitreal corticosteroid therapies in patients with diabetic macular edema (DME) and prior vitrectomized eyes in clinical practice. Methods: Retro-IDEAL was a 3-year retrospective, multicenter study in patients with chronic DME (i.e. DME that persists or recurs despite treatment) treated with ILUVIEN® (0.2 µg daily fluocinolone acetonide intravitreal implant), who had suboptimal outcomes with first-line vascular endothelial growth-factor inhibitors and other DME therapies. Results: A total of 81 eyes (63 patients) were included of which 39 eyes had undergone prior vitrectomy (PV group) while 42 eyes had not undergone prior vitrectomy (NPV). Baseline characteristics were balanced; however, more patients had proliferative diabetic retinopathy in the PV group vs. the NPV group (21.62% vs 9.38%, respectively). Over 36 months, mean visual acuity (VA) increased in both groups with a tendency for more ETDRS letters being gained in the NPV group (+5.33) vs. the PV group (+2.42). By month 36, central retinal thickness was reduced to ⩽300 µm in two-thirds of the eyes in both groups and the mean change from baseline in intraocular pressure was similar in both groups (+0.50 mmHg −0.75 mmHg; NPV and PV group). Conclusions: These long-term data suggest that the 0.2 μg/day FAc implant is effective in both vitrectomized and non-vitrectomized patients, with a manageable safety profile, and improved VA and reduced supplemental therapies for patients with a suboptimal response to first-line DME therapies. Clinicians may consider utilizing the FAc implant earlier in the DME disease process.

New Development and New Medicine in Treatment of Diabetic Retinopathy and Diabetic Macular Edema

2018 ◽  
pp. 185-188
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Diabetic Retinopathy ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vascular Endothelial ◽  
New Development ◽  
Endothelial Growth Factor ◽  
Hallmark Feature

The blood-retina barrier alteration is a hallmark feature of diabetic retinopathy. The vascular endothelial growth factor is an important vasopermeability factor that playing role in the pathogenesis of blood-retina barrier destruction. Inflammation is the second pathology in diabetic retinopathy. New researches are ongoing about both pathways for diabetic retinopathy and macular edema therapy.

scholarly journals Triamcinolone as an adjunct to the combination of anti-VEGF for the management of diabetic macular edema

2021 ◽  
Vol 14 (6) ◽  
pp. 869-874
Author(s):  
Ying-Ying Yu ◽  
◽  
Li-Bin Chang ◽  
Hui-Ka Xia ◽  
Xiao-Xin Li ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Cost Effective ◽  
Treatment Burden ◽  
Intravitreal Triamcinolone ◽  
Anti Vegf ◽  
Significant Difference ◽  
The Mean ◽  
Endothelial Growth Factor ◽  
Mean Cost

AIM: To assess the efficacy of intravitreal triamcinolone (IVTA) as an adjunct to the combination of anti-vascular endothelial growth factor (VEGF) for the management of diabetic macular edema (DME). METHODS: A total of 51 patients with visual disabilities causing by DME from two sites were retrospectively collected and assigned to two groups according to the therapeutic method: intravitreal conbercept (IVC) combined with focal laser (24 eyes) and IVC combined with focal laser and IVTA (27 eyes). Best-corrected visual acuity (BCVA), the required number of IVCs, central retinal thickness (CRT), the mean costs of treatment burden and safety were compared over 12mo. RESULTS: From baseline to month 1 through month 12, IVC combined with focal laser and IVTA improved the mean average change in BCVA superior to IVC combined with focal laser (+5.20 vs +2.71 letters). At month 12, 20.83% of the IVC combined with focal laser and 37.04% of IVC combined with focal laser and IVTA arms gained more than 10 BCVA letters. During the period, the mean CRT decreased significantly in the IVC combined with focal laser and IVTA arm (-245.9 μm) compared to the IVC combined with focal laser arm (-98.45 μm). The average of 6.45 and 1.25 conbercept injections performed in the IVC combined with focal laser and IVC combined with focal laser and IVTA arms, respectively. The mean cost of treatment burden for 12mo was $6247.44±4069.18 in the IVC combined with focal laser arm and $1679.19±542.73 in the IVC combined with focal laser and IVTA arm, with a statistically significant difference. Apart from occasional minor subconjunctival hemorrhage, no other significant ocular adverse events (AEs) were observed in either group during the12-month period. CONCLUSION: It is effective and cost-effective to treat DME by utilizing triamcinolone as an adjunct to the combination of anti-VEGF.

scholarly journals Pharmacotherapies for Diabetic Retinopathy: Present and Future

2007 ◽  
Vol 2007 ◽  
pp. 1-8 ◽  
Author(s):  
Stephen G. Schwartz ◽  
Harry W. Flynn
Keyword(s):  
Diabetic Retinopathy ◽  
Serum Lipids ◽  
Extended Release ◽  
Fluocinolone Acetonide ◽  
Management Control ◽  
Vascular Endothelial ◽  
Intravitreal Triamcinolone ◽  
Pars Plana ◽  
Endothelial Growth Factor ◽  
Preventable Blindness

Diabetic retinopathy remains a major cause of worldwide preventable blindness. Measures to avoid blindness include medical management (control of blood sugar, blood pressure, and serum lipids) and ocular management (laser photocoagulation and pars plana vitrectomy). Adjunctive pharmacologic therapies (intravitreal triamcinolone acetonide and anti-vascular endothelial growth factor agents) have shown early promise in the treatment of both diabetic macular edema and proliferative diabetic retinopathy. Other medications under investigation include the fluocinolone acetonide implantable device, extended-release dexamethasone implant, oral ruboxistaurin, and intravitreal hyaluronidase.

scholarly journals Diabetic macular edema: it is more than just VEGF

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 1019 ◽  
Author(s):  
Michael A. Singer ◽  
Daniel S. Kermany ◽  
Jana Waters ◽  
Michael E. Jansen ◽  
Lyndon Tyler
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Diabetic Retinopathy ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vascular Endothelial ◽  
Treatment Burden ◽  
Current Therapies ◽  
History Of ◽  
Endothelial Growth Factor

Diabetic macular edema is a serious visual complication of diabetic retinopathy. This article reviews the history of previous and current therapies, including laser therapy, anti-vascular endothelial growth factor agents, and corticosteroids, that have been used to treat this condition. In addition, it proposes new ways to use them in combination in order to decrease treatment burden and potentially address other causes besides vascular endothelial growth factor for diabetic macular edema.

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