Treating diabetic macular edema (DME) has evolved from the ETDRS-style focal/grid laser being the standard of care since 1985 to the modern era of pharmacotherapy—with anti-vascular endothelial growth factor (VEGF) injections now taking center stage as primary treatment for most patients.
Studies show DME may be driven by both VEGF and inflammatory cytokines, with cytokines playing a larger role in more severe cases.
Corticosteroids are frequently used in the subset of patients that do not respond sufficiently to anti-VEGF injections and have even been used as a first-line therapy in some studies. With that in mind, manufacturers have made available long-term implants to reduce the treatment burden for DME patients.
Most retina specialists are familiar with the 0.7 mg sustained-release dexamethasone intravitreal implant (Ozurdex, Allergan), approved by the FDA in June 2009. The implant has an approximate duration of 3 to 6 months.
In September 2014, the FDA approved a fluocinolone acetonide (FAc) intravitreal implant 0.19 mg (Iluvien, Alimera Sciences) for the treatment of DME in patients previously treated with corticosteroids without an adverse effect. Its duration is about 36 months.
The FAc implant is made of a non-biodegradable polyimide tube measuring 3.5 mm in length and 0.37 mm in diameter. It contains a permeable membrane of polyvinyl alcohol at one end, which initially releases 0.25 mcg/day of FAc in the vitreous. The implant is supplied in a sterile, single-use, preloaded applicator with a hollowed out 7.5-mm long, 25-gauge needle. It is covered with a protective cap and packaged in a sealed sterile tray that can be stored at room temperature.