Eyeworld

143 EW RETINA April 2016 Contact information Benedict: wbenedict@ECCNC.net Vanderveldt: svanderveldt@garetina.com take advantage of practice oppor- tunities with company representa- tives; however, I highly recommend attempting to use the injector while the representative is in office. The injector is not the press and release module with which most surgeons are familiar. It does take a bit of practice to become accustomed to the design. "In one unique case, I had a patient with an Iluvien implant who needed a vitrectomy for an unre- lated issue. I carefully left a small amount of peripheral vitreous where the implant was embedded while thoroughly removing the vitreous in all other areas. This worked well, and the implant remained in place even postoperatively. There have been no adverse problems thus far. "While my experience with Iluvien is still in the early stages, I have been happy with the results thus far. Most patients have done as well or better than with Ozurdex, although a few have needed sup- plementation with additional VEGF inhibitors. The risk of elevated IOP is always present with steroid use, 5 however, pressure problems are gen- erally easy to manage, and patients find that control of DME without a lifetime of repeated injections is a significant benefit. Maintaining cen- tral vision while subjecting the pa- tient to the least amount of discom- fort and inconvenience necessary is key. Long-acting implants make this possible. I would like to see this product approved for other applica- tions such as for use in uveitis cases and other conditions that require long-term steroid treatments." EW References 1. Ciulla TA, et al. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies. Diabetes Care. 2003;26:2653–2664. 2 Wang H, et al. Intravitreal ranibizumab (Lucentis) for the treatment of diabetic macular edema: a systematic review and meta-analysis of randomized clinical control trials. Curr Eye Res. 2012;37:661–670. 3. Felinski EA, et al. Glucocorticoid regulation of endothelial cell tight junction gene expres- sion: novel treatments for diabetic retinopathy. Curr Eye Res. 2005;30:949–957. 4. Campochiaro PA, et al. Sustained delivery fluocinolone acetonide vitreous inserts provide benefit for at least 3 years in patients with diabetic macular edema. Ophthalmology. 2012;119:2125–2132. 5. Sallam A, et al. Outcome of raised intraocu- lar pressure in uveitic eyes with and without a corticosteroid-induced hypertensive response. Am J Ophthalmol. 2009;148:207–13. Editors' note: The physicians have no financial interests related to their comments.

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