Intravitreal fluocinolone acetonide 0.19 mg Iluvien implant for radiation maculopathy

To evaluate the efficacy of a long-acting fluocinolone acetonide 0.19 mg Iluvien intravitreal (FAc) implant for the treatment of radiation maculopathy (RM).

Retrospective case series.

Seven patients treated for uveal melanoma with palladium-103 plaque brachytherapy who developed RM.

Patients initially received intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Those who were intolerant or refractory to anti-VEGF were transitioned to the FAc implant. The main outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), and central foveal thickness (CFT) on optical coherence tomography.

The median radiation dose to the fovea was 45.9 Gy (mean: 61.8, range: 6.4-135.6). RM onset occurred at a median of 12 months post-radiation. Patients received anti-VEGF therapy for 71 months (mean) before FAc implantation. A median of 1 (mean: 2, range: 1-3) FAc implant was placed per patient, beginning in 2018. Median follow-up was 45 months (mean: 39, range: 14-52). Median BCVA improved from 20/63 (mean: 20/63, range: 20/30-20/160) to 20/50 (mean: 20/50, range: 20/20-20/400). Median CFT decreased from 390 μm (mean: 458, range: 301-845) to 300 μm (mean 427) at 6 months, and 383 μm (mean 413) at the last follow-up. One patient required IOP-lowering treatment, and 3 were able to discontinue anti-VEGF therapy. Two patients required additional FAc implants after 4 years.

FAc implants were an effective treatment for RM patients who were refractory or intolerant to maximal intravitreal anti-VEGF therapy. They achieved positive results in the stabilization of macular edema and visual acuity, as well as reduced the intravitreal anti-VEGF injection burden for some patients.