title: Sustained-release fluocinolone acetonide intravitreal insert for macular edema: clinical pharmacology and safety evaluation.
abstract: BACKGROUND
  Inflammation plays a key role in the pathological processes leading to macular edema. Sustained release, low-dose intraocular corticosteroid delivery devices provide long-term anti-inflammatory therapy. Recently, a novel fluocinolone acetonide intravitreal insert (FAi, Iluvien), has been introduced with promising long-term results in the treatment of macular edema.
  
  
  METHODS
  An extensive review of the literature in the English language was performed to provide comprehensive information on the pharmacological properties of FAi and its safety and efficacy data from various multi-center randomized clinical trials.
  
  
  CONCLUSIONS
  The FAc, Retisert is a sustained-release device that is surgically implanted in the vitreous and has been approved by the US FDA for the treatment of non-infectious intermediate, posterior or panuveitis. FAi was developed after FAc and is an intravitreal corticosteroid delivery system that allows controlled release of therapeutic levels of fluocinolone acetonide (FA). Initial efficacy and safety data suggest that this delivery system maintains clinical effectiveness for up to 3 years after a single delivery of the device. This second-generation fluocinolone delivery device has shown superior safety results in clinical trials compared to the previous version of the higher dose FAc (0.59 mg). Sustained delivery preparations may help to reduce the treatment burden and its associated risks by decreasing the frequency of intravitreal injections. However, much needs to be learnt from additional clinical trials, post-marketing surveillance and results of extension studies. Concerns of intravitreal corticosteroids, such as cataract and increase in intraocular pressure, remain major challenges for this therapeutic strategy.
authors.affiliation: University of Nebraska Medical Center, Stanley M. Truhlsen Eye Institute, Ocular Imaging Research and Reading Center (OIRRC) , Omaha, NE 68198-5540 , USA.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Sadiq
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Agarwal
authors.forename: Mohamed K
authors.initials: MK
authors.lastname: Soliman
authors.forename: Mostafa
authors.initials: M
authors.lastname: Hanout
authors.forename: Salman
authors.initials: S
authors.lastname: Sarwar
authors.forename: Diana V
authors.initials: DV
authors.lastname: Do
authors.forename: Quan Dong
authors.initials: QD
authors.lastname: Nguyen
mesh_terms: D003692:Delayed-Action Preparations; D005446:Fluocinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D005938:Glucocorticoids / Q000008:administration & dosage / Q000493:pharmacokinetics; D006801:Humans; D015918:Infusion Pumps, Implantable; D008269:Macular Edema / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D003692:Delayed-Action Preparations; D005938:Glucocorticoids; D005446:Fluocinolone Acetonide; C035394:fluocinolone
keywords: fluocinolone acetonide; implant; intraocular injection; intravitreal steroid; macular edema; steroid; sustained release