Discontinuous to continuous therapy for persistent diabetic macular edema leads to reduction in treatment frequency

Abstract

Objective: To evaluate, in the setting of persistent diabetic macular edema, the impact that continuous fluocinolone acetonide delivery has on treatment burden, visual acuity, central retinal thickness, and intraocular pressure. Materials and methods: A single-center, retrospective, cohort study of patients with persistent diabetic macular edema, previously treated with anti–vascular endothelial growth factor injections, dexamethasone implants, or focal laser, who were subsequently treated with fluocinolone acetonide was conducted. All retinal visits were analyzed prior to fluocinolone acetonide, until the most recent follow-up visit. Primary outcomes were pre– and post–fluocinolone acetonide changes in the best-corrected visual acuity and number of treatments required for diabetic macular edema. Secondary outcomes included changes in the central retinal thickness and intraocular pressure. Results: A total of 19 eyes with persistent diabetic macular edema were included and followed for a mean (SD) of 399.3 (222.9) days. Post–fluocinolone acetonide, the mean best-corrected visual acuity improved by 0.4 ETDRS letters for all eyes ( p = 0.895) and the central retinal thickness decreased by 34.2 µm ( p = 0.077). After fluocinolone acetonide, the number of treatments decreased from an average of one treatment every 2.7 months to one every 6 months ( p = 0.009). Furthermore, post–fluocinolone acetonide, 10/19 eyes (52.6%) did not require additional treatment due to a dry macula, and those who did experienced a non-statistically significant reduction of treatments, from one every 2.6 months pre–fluocinolone acetonide, to one every 2.8 months post–fluocinolone acetonide ( p = 0.622). Conclusions: In the setting of persistent diabetic macular edema, fluocinolone acetonide significantly reduces the therapeutic burden, while maintaining best-corrected visual acuity and improving the central retinal thickness. In patient-centered discussions, judiciously employing fluocinolone acetonide should be performed to mitigate this therapeutic burden for patients.