Efficacy of fluocinolone acetonide implant in diabetic macular edema patients previously treated with dexamethasone implant: A systematic review and meta-analysis

Abstract

Background & Objective: Several diabetic macular edema (DME) patients are resistant to anti-vascular endothelial growth factors (VEGF) injections and are treated with corticosteroid implants. Dexamethasone implants (DEXI) are popular, but fluocinolone acetonide implants (FACI) are being used as third-line DME therapy, given their convenience and prolonged action. The efficacy of FACI in patients previously treated with DEXI remains understudied. We collated evidence from single-arm studies examining the efficacy and safety of FACI in DME patients treated with DEXI.

Methodology: We explored the websites of Embase, PubMed, PubMed CENTRAL, Web of Science, and Scopus up to January 15, 2025. Pre and post-FACI best-corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP) were compared.

Results: Eight studies with 365 eyes were included. Meta-analysis showed that use of FACI was associated with statistically significant improvement in BCVA (letters) at three months (MD: 5.40 95% CI: 0.13, 10.67 I2= 78%) but not at six months (MD: 5.43 95% CI: -1.79, 12.64 I2=86%), and 12 months (MD: 3.39 95% CI: -3.12, 9.91 I2=84%). The pooled analysis indicated a statistically significant reduction in CRT after administration of FACI at 3 months (MD: -118.11 95% CI: -211.62, -24.61 I2=93%), six months (MD: -121.79 95% CI: -212.35, -31.24 I2=94%), and 12 months (MD: -108.33 95% CI: -175.47, -41.2 I2=92%). No significant change in IOP was noted at all follow-up intervals.

Conclusions: Use of FACI in patients previously treated with DEXI results in anatomical improvement but may be associated with limited visual gain. The use of FACI seems safe without significant change in IOP.