TY - JOUR
TI - The outcome of fluocinolone acetonide intravitreal implant is predicted by the response to dexamethasone implant in diabetic macular oedema
AU - Cicinelli, M.V.
AU - Rosenblatt, A.
AU - Grosso, D.
AU - Zollet, P.
AU - Capone, L.
AU - Rabiolo, A.
AU - Lattanzio, R.
AU - Loewenstein, A.
AU - Bandello, F.
AU - Nassisi, M.
AU - Tan, A.
AU - Reynolds, R.
AU - Singh, S.R.
AU - Vaezi, K.P.
AU - Giocanti-Aurégan, A.
AU - Weinberg, T.
AU - Faes, L.
AU - Schwartz, R.
AU - Reyes, D.Y.A.
AU - Savastano, A.
AU - Touhami, S.
AU - Garcia, H.R.
AU - Pohlmann, D.
AU - Plant, A.
AU - Ventura, C.V.
AU - Chatziralli, I.
AU - Phasukkijwatana, N.
AU - Ruiz-Medrano, J.
AU - Yuan, M.
AU - Yılmaz, İ.
AU - Vogt, D.
AU - Ting, D.S.W.
AU - Mustapha, M.
AU - Mendaro, M.
AU - On behalf of the International Retina Collaborative
JO - Eye (Basingstoke)
PY - 2021
VL - 35
TODO - 12
SP - 3232-3242
PB - Springer Nature BV
SN - null
TODO - 10.1038/s41433-020-01373-1
TODO - null
TODO - 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. © 2021, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.
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