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Diabetic Macular Oedema Changing Perspectives in Diabetic Macular Oedema – Recognising and Understanding Chronic Diabetic Macular Oedema Proceedings of a Symposium Presented at the 14 EURETINA Congress, London, 12 September 2014 Expertly Reviewed by: Usha Chakravarthy 1 Symposium Speakers: Albert Augustin, 2 Yit Yang, 3 Michael Diestelhorst 4 and Pascale Massin 5 1. Ophthalmology and Vision Sciences, Queen’s University Belfast, UK; 2. Augenklinik Karlsruhe, Karlsruhe, Germany; 3. Wolverhampton Eye Infirmary, New Cross Hospital, Wolverhampton, UK; 4. Department of Ophthalmology, University of Cologne, Cologne, Germany; 5. Hôpital Lariboisière, Paris, France Abstract The satellite symposium moderated by Usha Chakravarthy entitled ‘Changing Perspectives in Diabetic Macular Oedema: Recognising and Understanding Chronic Diabetic Macular Oedema’ was convened at the 2014 EURETINA Congress. The symposium discussed the multiple processes involved in chronic diabetic macular oedema (DMO) and the use of medications, in particular, corticosteroids in its management. As DMO progresses, inflammatory cytokines are up-regulated relative to vascular endothelial growth factor (VEGF) and these promote various pathways that ultimately result in retinal damage in chronic disease. It is important therefore that treatments for chronic DMO address this altered inflammatory cytokine profile to effectively manage the condition. ILUVIEN ® , a 190 µg intravitreal implant in applicator (with a daily release rate of 0.2 µg/day fluocinolone acetonide [FAc] implant) is a second-line therapy indicated for the treatment of chronic DMO. This implant has been shown in phase III trials to lead to marked improvements in visual acuity and in retinal thickness in patients with chronic DMO that were insufficiently response to first-line therapy (i.e. laser). Clinical trial data strongly support the use of the FAc implant in chronic DMO and now ‘real world’ data from its use in regular clinical practice are becoming available and interim results complement those reported in a clinical trial setting. Keywords Diabetic macular oedema, intravitreal corticosteroid, 190 µg fluocinolone acetonide intravitreal implant in applicator (ILUVIEN), visual acuity, FAME studies, FAMOUS studies Disclosure: Usha Chakravarthy, Albert Augustin, Yit Yang, Michael Diestelhorst and Pascale Massin have attended advisor boards and speaker engagements and have been remunerated for these by Alimera Sciences Ltd. Acknowledgements: Editorial assistance was provided by James Gilbart at Touch Medical Media, London, UK. Received: 22 October 2014 Accepted: 18 November 2014 Citation: European Ophthalmic Review, 2014;8(2):145–51 Correspondence: Usha Chakravarthy, Clinical Professor, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Northern Ireland, UK. E: u.chakravarthy@qub.ac.uk Support: The publication of this article was funded by Alimera Sciences Ltd. The views and opinions expressed are those of the authors and not necessarily those of Alimera. Diabetic macular oedema (DMO) is a serious threat to vision that is showing increasing prevalence as a consequence of the worldwide increase in both type I and type II diabetes. 1 DMO affects approximately 7 % of people with diabetes and is responsible for 12 % of new cases of blindness each year. 2,3 In many cases, diabetes leads to diabetic retinopathy (DR) approximately 10 years after disease onset and this can lead to DMO. In some cases, however, DMO can occur without DR. Effective means of controlling DMO to prevent widespread vision loss is a growing need. Until recently, the only treatment that was available for the management of DR and DMO was argon laser photocoagulation but now new pharmacological treatments are emerging that are improving the understanding of this disease and enabling better patient outcomes. 4,5 Two classes of intravitreal injections include inhibitors of vascular endothelial growth factor (VEGF) and corticosteroids. These treatments provide a much improved choice for the management of DMO and, in the case of corticosteroid treatments, can © To u ch MEd ica l MEdia 201 4 sustain long-term improvements (in visual acuity and reduced macular oedema) for up to 3 years. 6 In some patients, such medicines are used too late in the disease course and optimal outcomes in terms of vision and retinal thickness are consequently not achieved. 7–9 This is one of the matters that was discussed at the symposium held by Alimera Sciences at the 2014 EURETINA congress in London. This article reports the proceedings from this symposium. Objectives of the Symposium The symposium aimed to consider the inflammatory processes involved in chronic DMO, to review the clinical trial data supporting the use of fluocinolone acetonide (FAc) implant therapy and to report important interim findings from a ‘real world’ study of this treatment in early regular clinical use (non-randomised, open label, single-centred, phase IV efficacy and safety study) that is in progress at a treatment centre in France. n 145