Fluocinolone acetonide for the treatment of diabetic macular edema

In addition to VEGF inhibitors such as ranibizumab, aflibercept or bevacizumab, clinical and experimental investigations have revealed the great potential of steroids in the treatment of DME. At present two intravitreal steroid inserts are approved for the treatment of DME containing either dexamethasone or fluocinolone acetat (FA) as a pharmacological compound. The non degradable intravitreal FA insert releases 0.2 mu g FA per day (Iluvien, Alimera Sciences). Clinical phase III studies have demonstrated the beneficial effect of the FA insert to last up to three years, especially in patients with a prolonged history of DME of at least three years at the initiation of therapy. While the treatment appears to be well tolerated over all, side effects such as cataract formation in nearly all treated phakic patients and raise of intraocular pressure need to be discussed with the patients as potential complications of the treatment.