Abstract
PurposeTo report the 12-months visual and anatomical outcomes of chronic diabetic macular oedema (DMO) treated with ILUVIEN in a real-world clinical practice in a single tertiary referral centre.MethodRetrospective data collection and analysis of consecutive 28 eyes of 23 diabetic patients received ILUVIEN implant for refractory DMO. Standard assessment included visual acuity (VA), central retinal thickness (CRT), slit-lamp biomicroscopy, and Goldmann tonometry for intraocular pressure (IOP) at 1, 6, and 12 months.ResultsBaseline mean VA was 47 (SD 18) letters improved to 55 (SD 17) letters (P=0.004) at 12 months. VA was improved in 16 eyes (57%), stabilised in 9 eyes (32%), and decreased in 3 eyes (11%). Seven eyes (25%) gained ≥15 letters, and 10 eyes (36%) gained >10 letters from baseline. The percentage of eyes achieved driving vision (≥70 Early Treatment Diabetic Retinopathy Study letters) was doubled from baseline 18 to 36% at 6 months and 32% at 12 months. Mean CRT decreased by 198 μm from baseline 494 μm (SD 191) to 296 μm (SD 121) at 12 months (P<0.001). Two eyes received additional anti-vascular endothelial growth factor injections after 10 months. Complications: Raised IOP in three eyes (11%) controlled with IOP-lowering drops, vitreous haemorrhage in one eye and one endophthalmitis (1 year vision improved to 6/24).ConclusionOur real-world results show that the visual and the anatomical improvements achieved by a single ILUVIEN implant injection were maintained up to 12 months with minimal adjunctive therapy. IOP monitoring remains essential in ILUVIEN patients, although our study shows a relatively low risk of IOP elevation post ILUVIEN injection, even in existing controlled ocular hypertension. Our results demonstrate that ILUVIEN is an effective long-term option in treating chronic refractory DMO.
Highlights
Diabetic macular oedema (DMO), as the common complication in diabetic retinopathy, is the leading cause of blindness in the working population among patients aged 20 to 70 years in developed countries.[1,2] The pathophysiology of DMO is a complex process with numerous biochemical and histopathological abnormalities whereby hyperglycaemia initiates molecular pathways leading to dilated capillaries, retinal microaneurysms, and loss of pericytes.[3]
Our study shows the risk of intraocular pressure (IOP) elevation secondary to ILUVIEN implant injection was not higher in patients with controlled ocular hypertension (OHT) compared with patients without OHT
Our real-world single-centre results demonstrate that ILUVIEN offers a significant long-term benefit for patients with chronic DMO inadequately responsive to other available therapies
Summary
Diabetic macular oedema (DMO), as the common complication in diabetic retinopathy, is the leading cause of blindness in the working population among patients aged 20 to 70 years in developed countries.[1,2] The pathophysiology of DMO is a complex process with numerous biochemical and histopathological abnormalities whereby hyperglycaemia initiates molecular pathways leading to dilated capillaries, retinal microaneurysms, and loss of pericytes.[3]. A large number of physiological and molecular factors, including angiogenesis, inflammation, and oxidative stress, are involved in the pathogenesis of DMO.[5,6,7,8] The underlying pathogenesis is usually multifactorial, especially in chronic and refractory DMO
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