Steroids Likely to Help Diabetes

08 Dec Steroids Likely to Help Diabetes

Ok, maybe a bit dramatic, but another article was recently published stating that intravitreal injections were used with success to treat diabetic macular edema.   These effects lasted at least 5 years, the duration of the study.

This was a small study where two groups were compared.  One group received intravitreal injections of triamcinalone (a steroid) for the treatment of diabetic macular edema.  The second group received a placebo.

After two years, the second group then started receiving the steroid.  The first group continued.  Occasionally, laser was used in either group.

The results were that vision improved and swelling decreased in the first group.  In the second group, the vision improved and swelling decreased, but only after receiving the steroids.

What Does This Mean? The other day, I reviewed a small study (Eye Injections Challenge Eye Laser for Diabetic Retinopathy) and had a few criticisms.  This study, too, has the same pitfalls.  Don’t take away that all small studies are worthless, they are not.

A few months ago, there was some discussion regarding a couple of emerging new drug delivery systems available for ophthalmic use.  Iluvien® (Alimera) is an injectable sustained release system that will release steroid (fluocinalone) for the treatment of diabetic macular edema.  Clinical trials are underway.

Ozurdex™ (Allergan) is the first sustained drug delivery system to hit the market.  It was approved last June 2009 by the FDA for treatment of macular edema caused by retinal vein occlusions.  Though not approved directly for the treatment of macular edema found in diabetic retinopathy, my prediction is that it will be used “off-label” in the near future.

I think, slowly, we are moving to the point where intravitreal injections are going to replace laser therapy for the treatment of diabetic macular edema.  I am using the term “injections” rather loosely as I also am including the use of sustained release systems.  These, too, will be delivered by an injection method, similar to intraocular injections.  The only difference is that the sustained release systems will deliver the pharmaceutical over a much longer period, thus, requiring fewer “treatments.”

The full article is referenced here;  Ophthalmology. 2009;116(11):2182-2187.  There is no link as viewing may require a subscription.

“Randy”

Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia