A fluocinolone acetonide implant can improve retinal thickness variability (RTV) and treatment burden in patients with diabetic macular edema (DME), regardless of baseline best-corrected visual acuity (BCVA), according to a report published in Retina.
Researchers analyzed data from an observational study evaluating the association of baseline BCVA with visual, treatment burden, and RTV outcomes, as well as any intraocular pressure (IOP)-related events following implantation of a 0.19 mg fluocinolone acetonide implant.
The study included 202 eyes of 159 patients with DME who did not have a clinically significant rise in IOP following previous corticosteroid treatment. The researchers segregated data by baseline BCVA, and analyzed it for BCVA changes, number of yearly supplemental DME treatments, RTV, and incidence of IOP-related event.
The study found that eyes with better baseline BCVA ( ≥20/40) maintained baseline BCVA, while vision in eyes with worse baseline BCVA (<20/40) increased by approximately 7 letters to 61.34 letters (P <.05), at 36 months after receiving the fluocinolone acetonide implant. A decrease was observed in treatment burden and RTV post-fluocinolone acetonide implant, regardless of baseline BCVA.
Additionally, fewer IOP-related events post-implant occurred in eyes with better baseline BCVA compared with eyes with worse baseline BCVA, including a lower incidence of incisional IOP-lowering surgery.
“Though anti-VEGF therapies remain the current first-line standard of care, there remains a significant proportion of eyes that do not respond well, in some cases potentiated by patient non-adherence with strict anti-VEGF treatment regimens, ultimately leading to poor disease control and unrecoverable vision loss,” according to the researchers. “Thus, anti-VEGF monotherapy may not be the best option for many patients with DME and may even put them at a disadvantage in terms of BCVA, quality of life, and anatomical outcomes.”
The researchers note the potential study limitation that, while patients with worse baseline BCVA have a greater capacity to achieve clinically meaningful visual gains during treatment for DME, those with better baseline BCVA experience a plateau effect in terms of ability to gain vision following treatment.
Gonzalez VH, Luo C, Almeida DRP, et al. Better baseline vision leads to better outcomes after the 0.19-mg fluocinolone acetonide intravitreal implant in diabetic macular edema. Retina. Published online May 1, 2023. doi:10.1097/IAE.0000000000003827