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OBJECTIVES: to evaluate long-term effectiveness and safety of fluocinolone acetonide (FAc) implant used as second-line treatment in patients with persistent diabetic macular edema (DME). METHODS: retrospective data chart review of 241 pseudophakic eyes of 178 patients treated with FAc from July 2017 to December 2021 in 10 medical retinal units in Italy. The primary endpoint was the change of best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 2 years. A Student's paired t-test was used. Additional therapies for DME and intraocular pressure (IOP)-related events were also evaluated. RESULTS: efficacy of FAc was assessed in a subset of 111 eyes with at least 24 months of follow-up. Mean BCVA increased at 2 years by 5.1 ETDRS letters (95%CI = 2.6-7.5; p < 0.001) while mean CMT decreased by 189 µm (95% CI 151-227; p < 0.001). Thirty-eight of these eyes (34.2%) needed additional intravitreal treatments, mainly anti-VEGF. Safety was evaluated on the entire cohort of 241 eyes treated with FAc. Overall, 66 eyes (27.4%) required emergent IOP-lowering medications (typically within the first-year post FAc) while 14 eyes (5.8%) underwent trabeculectomy, mostly during the second year of follow-up. CONCLUSION: FAc implant provides a substantial long-term functional and anatomical benefit when used as second-line treatment in eyes with DME. IOP rise can be adequately managed with topical agents although some eyes may require IOP-lowering surgery.
RESUMEN
AIM: To evaluate morphological characteristics of optic nerve head (ONH) and fovea (F) related to axial length (AL) in healthy eyes. METHODS: This is an observational study. A consecutive series of healthy subjects was enrolled. Demographic and clinical parameters were age, gender, eye, intraocular pressure, spherical equivalent, AL. Tomographic parameters were ONH-F distance, ONH-F angle, horizontal and vertical ONH diameters, retinal nerve fiber layer (RNFL) thickness and foveal profile patterns. RESULTS: One hundred six eyes (56 patients) were recruited. A correlation between AL and ONH-F distance was demonstrated (p = 0.0342). Horizontal diameter decreased with increasing AL (p = 0.0003), conferring to ONH a more oval shape. A significant decrease in RNFL thickness was correlated with AL, except for temporal quadrant. Two foveal profile patterns were described: concave and straight patterns. Eyes with concave pattern were longer than eyes with straight pattern. CONCLUSION: Eye elongation affects the morphology of the ONH, the fovea and the distribution of retinal nerve fibers.