title: Use of flucinolone acetonide for patients with diabetic macular oedema: patient selection criteria and early outcomes in real world setting.
abstract: BACKGROUND
  Fluocinolone acetonide slow release implant (Iluvien®) was approved in December 2013 in UK for treatment of eyes which are pseudophakic with DMO that is unresponsive to other available therapies. This approval was based on evidence from FAME trials which were conducted at a time when ranibizumab was not available. There is a paucity of data on implementation of guidance on selecting patients for this treatment modality and also on the real world outcome of fluocinolone therapy especially in those patients that have been unresponsive to ranibizumab therapy.
  
  
  METHODS
  Retrospective study of consecutive patients treated with fluocinolone between January and August 2014 at three sites were included to evaluate selection criteria used, baseline characteristics and clinical outcomes at 3-month time point.
  
  
  RESULTS
  Twenty two pseudophakic eyes of 22 consecutive patients were included. Majority of patients had prior therapy with multiple intravitreal anti-VEGF injections. Four eyes had controlled glaucoma. At baseline mean VA and CRT were 50.7 letters and 631 μm respectively. After 3 months, 18 patients had improved CRT of which 15 of them also had improved VA. No adverse effects were noted. One additional patient required IOP lowering medication. Despite being unresponsive to multiple prior therapies including laser and anti-VEGF injections, switching to fluocinolone achieved treatment benefit.
  
  
  CONCLUSIONS
  The patient level selection criteria proposed by NICE guidance on fluocinolone appeared to be implemented. This data from this study provides new evidence on early outcomes following fluocinolone therapy in eyes with DMO which had not responded to laser and other intravitreal agents.
authors.affiliation: Wolverhampton Eye Infirmary, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK. i_melaroud@hotmail.com.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Elaraoud
authors.affiliation: Wolverhampton Eye Infirmary, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK. walter.andreatta@uhb.nhs.uk.
authors.forename: Walter
authors.initials: W
authors.lastname: Andreatta
authors.affiliation: Queen Elizabeth University Hospital Birmingham, Birmingham, B15 2TH, UK. andrea.kidress@uhb.nhs.uk.
authors.forename: Andrej
authors.initials: A
authors.lastname: Kidess
authors.affiliation: Wolverhampton Eye Infirmary, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK. ajay.bhatnagar@nhs.net.
authors.forename: Ajay
authors.initials: A
authors.lastname: Bhatnagar
authors.affiliation: Queen Elizabeth University Hospital Birmingham, Birmingham, B15 2TH, UK.
authors.forename: Marie
authors.initials: M
authors.lastname: Tsaloumas
authors.affiliation: Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK. fahdquhill@outlook.com.
authors.forename: Fahad
authors.initials: F
authors.lastname: Quhill
authors.affiliation: Wolverhampton Eye Infirmary, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK. yit.yang@nhs.net.|School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK. yit.yang@nhs.net.
authors.forename: Yit
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000188:drug therapy*; D004343:Drug Implants; D005260:Female; D005446:Fluocinolone Acetonide / Q000008:administration & dosage*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008269:Macular Edema / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012160:Retina / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D004343:Drug Implants; D005938:Glucocorticoids; D005446:Fluocinolone Acetonide