Off-Label Use of 0.19 mg Fluocinolone Acetonide Intravitreal Implant: A Systematic Review

Area of Science:

• Ophthalmology
• Retinal Diseases
• Ocular Drug Delivery

Background:

• Corticosteroids are crucial for treating ocular diseases, but effective delivery to the posterior eye segment remains a challenge.
• Sustained-release corticosteroid implants offer a potential solution for sustained ocular drug delivery.
• The 0.19 mg fluocinolone acetonide (FAc) implant (Iluvien®) is approved for diabetic macular edema and noninfectious uveitis.

Purpose of the Study:

• To systematically review the off-label uses of the fluocinolone acetonide (FAc) implant in ophthalmology.
• To identify and analyze studies investigating FAc implant use in conditions beyond its approved indications.

Main Methods:

• A systematic literature search was conducted in PubMed, Scopus, and Web of Science from January 2000 to September 2020.
• The search query included terms related to "Fluocinolone Acetonide" or "Iluvien®" and "eye," "ocular," or "intravitreal."
• Eleven papers were included, analyzing FAc implant use in specific ophthalmic diseases.

Main Results:

• The FAc implant was evaluated for off-label use in radiation-induced maculopathy, paraneoplastic visual syndromes (MAR, CAR), Sjogren's syndrome-related keratopathy, retinal vein occlusion, cystoid macular edema, diabetic retinal neurodegeneration, and retinitis pigmentosa.
• Preliminary findings suggest the FAc implant may be a potential treatment option for these conditions.
• The scientific evidence supporting these off-label uses is currently limited.

Conclusions:

• The fluocinolone acetonide (FAc) implant demonstrates potential utility in treating a range of ophthalmic conditions beyond its current approvals.
• However, the existing studies have limitations in terms of cohort size and follow-up duration.
• Further robust clinical trials are essential to validate the efficacy and safety of FAc implants for these off-label indications.