Nancy Holekamp, MD, joins Victor Gonzalez, MD, to talk about the role of inflammation in diabetic macular edema (DME). Dr. Holekamp explains how inflammatory cytokines are expressed at higher levels in eyes with DME compared with non-DME eyes, and refers to a study that correlates levels of cytokines with the severity of retinopathy. She provides insight into how to manage these levels when treating patients and stresses the importance of researching the effect of corticosteroids to better understand the pathophysiology of DME.
Nathan Radcliffe, MD, sits down with Nancy Holekamp, MD, to discuss intravitreal corticosteroid injection with Iluvien (Alimera Sciences) for the treatment of diabetic macular edema (DME). Dr. Radcliffe reviews the more common adverse reactions (e.g., cataracts and elevated IOP) associated with ocular steroid use and the incidence of those events in the FAME clinical trial, which compared use of Iluvien with sham over a 36-month period. He also discusses how many patients fit the current FDA indication for Iluvien and what happened to those patients in the clinical trial.
Victor Gonzalez, MD, speaks with Nancy Holekamp, MD, regarding a case in which he used Iluvien (Alimera Sciences) to treat an 82-year-old woman with diabetic macular edema (DME). She had a poor response to previous treatment with anti-VEGF injections, but intravitreal injections of dexamethasone resolved her center-involving macular edema. Dr. Gonzalez says he chose to treat the patient with Iluvien because she had rapid recurrence of the macular edema without continued treatment every 3 months. The patient’s visual acuity improved from 20/400 to 20/100 2 months after receiving the Iluvien intravitreal implant.
Hosted By Nancy Holekamp, MD Director, Retina Services and the Center for Macular Degeneration Pepose Vision Institute Chesterfield, MO View the archived video of the Simulcast USA National Launch Event for ILUVIEN March 2, 2015. Webcast includes video from six locations across the USA.
ILUVIEN® (fluocinolone acetonide intravitreal implant) 0.19 mg is indicated for the treatment of diabetic macular edema (DME) in patients who have been previously treated with a course of corticosteroids and did not have a clinically significant rise in intraocular pressure.
• ILUVIEN is contraindicated in patients with active or suspected ocular or periocular infections including most viral diseases of the cornea and conjunctiva including active epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections and fungal diseases.
• ILUVIEN is contraindicated in patients with glaucoma, who have cup to disc ratios of greater than 0.8.
• ILUVIEN is contraindicated in patients with known hypersensitivity to any components of this product.
• Intravitreal injections, including those with ILUVIEN, have been associated with endophthalmitis, eye inflammation, increased intraocular pressure, and retinal detachments. Patients should be monitored following the intravitreal injection.
• Use of corticosteroids including ILUVIEN may produce posterior subcapsular cataracts, increased intraocular pressure and glaucoma. Use of corticosteroids may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses. Corticosteroids are not recommended to be used in patients with a history of ocular herpes simplex because of the potential for reactivation of the viral infection.
• Patients in whom the posterior capsule of the lens is absent or has a tear are at risk of implant migration into the anterior chamber.
• In controlled studies, the most common adverse reactions reported were cataract development (ILUVIEN 82%; sham 50%) and intraocular pressure elevation of ≥ 10 mm Hg (ILUVIEN 34%; sham 10%).