Intravitreal steroid implants for DME

Steroids address the multifactorial nature of diabetic macular oedema (DME) via inhibition of various signalling pathways within the eye, Anat Loewenstein MD, Tel Aviv Medical Center, Israel, told delegates at the 15th EURETINA Congress in Nice.

Speaking before a packed auditorium, she reviewed the literature on intravitreal steroid implants for DME, with particular emphasis on the Illuvien® intravitreal fluocinolone implant and the Ozurdex® intravitreal dexamethasone implant.

“With these sustained-release steroid implants, BCVA improvement of at least 15 letters was greatest in patients with chronic DME,” said Dr Loewenstein. “Patients also often respond after failure of anti-VEGF treatment regimens.”

“The implants’ sustained release of the active molecule over many months also allows for a decreased number of intravitreal injections, with a lower burden on both patients and the healthcare system,” she added.

“The first report of a five-year follow-up indicates that 90 per cent of patients no longer need DME treatment two years after the end of a three-year clinical study treatment regimen.”

Dr Loewenstein also addressed the well-known side-effects of intravitreal steroids.

“Although the incidence of cataract in phakic patients is very high, from 60 to 80 per cent, patients who underwent cataract surgery eventually gained the same visual benefit as pseudophakic patients. Approximately 40 per cent of eyes experienced increased intraocular pressure (IOP), and depending on the duration of the study, between one and five per cent of patients require a filtering procedure to control this increased IOP,” she said.