Treat diabetic macular oedema with one eye injection in three years?


It may sound too good to be true but a new injectable steroid product is now on the market in the UK and comes with the claim that only one injection is required which can last three years. This product called Iluvien (drug name fluocinolone) is new slow release implant product licensed to treat diabetic macular oedema.Diabetic macular oedema is a major cause of sight loss in patients with diabetes. Previously treatment options were limited to laser which rarely improved vision but helped stabilized the condition. More recently the introduction of Lucentis and Avastin injection treatments has improved the prognosis for this condition considerably.
In particular for Lucentis there are now a number of large studies confirming its benefit and also showing that the results are superior to laser treatment.
There appears to be only a small additional benefit of laser versus Lucentis treatment alone. Recently NICE has approved this treatment on the National Health Service. This is good news for patients in Manchester where a higher proportion of patients are affected by diabetes compared to the UK average.
Although Lucentis is a great option for diabetic macular oedema it does require a commitment to regular hospital visits and regular monthly treatment and in the first year of treatment on average 7 to 8 injections may be required. In the second year, most people may need less only 3-5 injections and if good control of the diabetes and blood pressure can be maintained then I would expect the number of injections required to maintain vision per year to remain quite low.
Lucentis works by blocking the chemical “vascular endothelial growth factor”. In diabetics this chemical is a factor in causing diabetic retinopathy and macular oedema. However, there are also raised levels of many different chemicals which contribute to inflammation. It therefore makes sense to consider steroid treatment as well. Steroids have been less popular in the past because of potential side effects included raised pressure and cataract. However, pressure in the majority is manageable with eye drops and we have effective treatment for cataract.
The studies of Iluvien have shown that a single implant injection can slowly release a small dose of steroid continuously for a couple of years. In diabetics who have been affected by macular oedema for a number of years and other therapies are failing this looks like an effective option. In the iluvein studies, over 30% of patients had meaningful improvement in vision after three years versus only 13% without. A single implant injection and then periodic monitoring visits to check progress and watch for side effects is an attractive option.
If you know you have diabetic macular oedema and your current treatments do not appear to be working and you want to be considered for such therapy or want a second opinion then arrange a consultation with Mr Mahmood.

Appointment times can be worked flexibly around your needs and may be accommodated on evenings and weekends.
You can also be seen at a private hospital close and convenient for you.


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