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Fluocinolone acetonide and its potential in the treatment of chronic diabetic macular edema

Authors Haritoglou C, Neubauer AS, Kernt M

Received 18 January 2013

Accepted for publication 7 February 2013

Published 8 March 2013 Volume 2013:7 Pages 503—509

DOI https://doi.org/10.2147/OPTH.S34057

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5

Christos Haritoglou, Aljoscha S Neubauer, Marcus Kernt

Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany

Abstract: Diabetic macular edema (DME) is a potentially sight-threatening disease that predominantly affects patients with type 2 diabetes. The pathogenesis is complex, with many contributing factors involved. In addition to overexpression of vascular endothelial growth factor in the diabetic eye, there is an inflammatory pathway that contributes to the breakdown of the blood-retina barrier and nonperfusion. In addition to vascular endothelial growth factor inhibitors, clinical and experimental investigations underline the great potential of steroids in the treatment of DME. Fluocinolone acetonide is currently the only corticosteroid approved for the treatment of DME in Europe. It is manufactured as an intravitreal insert, releasing fluocinolone acetonide at a rate of 0.2 µg per day. Phase III clinical studies have demonstrated that the beneficial effect of the fluocinolone acetonide insert lasts up to 3 years. Improvement in visual acuity was especially remarkable in patients with a prolonged duration of DME of at least 3 years at the initiation of therapy. Cataract formation occurs in nearly all phakic eyes treated, and needs to be considered when the indication for treatment is made. Given the efficacy versus potential complications of the insert, fluocinolone acetonide represents a promising second-line treatment option in patients with DME. Fluocinolone appears to be especially beneficial for patients whose options for visual recovery have seemed limited up until now.

Keywords: diabetic macular edema, fluocinolone acetonide

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