On Sept 29, 2015; Dr. James Lai, from the Retina Consultants of Hawaii, treated a diabetic patient with the first ILUVIEN® implant in the state of Hawaii. ILUVIEN® is a long acting steroid implant which can be injected into the eye to treat patients with diabetic macular edema (swelling in the lining of the back of the eye, aka retina)
What is Diabetic Macula Edema?
Currently, there are over 29 million (9.3%) Americans and 600,000 Hawaiians diagnosed with diabetes mellitus. Diabetes mellitus is disease in which the patient has an abnormally high blood glucose (sugar). Long term, high levels of blood glucose causes damage to the blood vessels that supply nutrients to the heart, kidneys, brain, and the eyes. This can result in many complications including stroke, heart attack, and vision loss. Specifically, diabetes affecting the eye is termed “diabetic retinopathy.”
Diabetic retinopathy is one of the leading causes of vision loss in the United States. Vision loss from diabetes can occur when there is a lack of blood flow to the eye, or when blood vessels are leaking. When there is leakage and swelling, this is called diabetic macular edema (DME). These leaking vessels create swelling in the retina which in turn causes decreased central vision and can be permanent if left untreated. Diabetic macular edema affects over 750,000 Americans.
Treatment of DME includes laser, intravitreal injections (injection directly into the eye) with anti-vascular endothelial growth factor (VEGF) agents (bevacizumab, ranibizumab, aflibercept), and intravitreal steroids. Steroids play an important role in patients who do not respond to first-line treatments with laser and anti-VEGF therapy.
This is a unique treatment that offers a long-term drug delivery system for the treatment of diabetic macular edema. The implant releases fluocinolone acetonide, (0.2 micrograms/day) which is a steroid that treats the inflammatory component of DME and can significantly reduce the swelling in the back of the eye. The implant is very small, less than the size of a grain of rice, and can last up to 3 years. Before ILUVIEN®, the only available long-term corticosteroid treatment lasted only 3-6 months. In addition, the small size lends itself to have minimal side effects for patients. ILUVIEN® is given in the office in a relatively quick (less than 2 minutes) and painless injection.
Roberta Supebedia is the first patient in Hawaii that has received the Iluvien implant. She has diabetic macular edema in both eyes that has required multiple injections with anti-VEGF therapy and corticosteroid implants. Roberta describes her experience as that of “amazement” and is eager to have the implant placed in the other eye.
“We are very excited to offer this revolutionary treatment to our diabetic patients. The Iluvien implant offers a long lasting alternative treatment for diabetic retinopathy that may control the swelling in the retina with simply 1 injection every 3 years.” Dr. Lai also stated that, “ The Retina Consultants of Hawaii has been and continues to be involved in all the newest clinical trials for the treatment of various retinal diseases such as diabetic retinopathy and macular degeneration. Our goal is to provide the latest cutting edge treatment for the patients here in Hawaii.”
On top left, the applicator used to inject the implant. On top right, the actual relative size of the ILUVIEN® implant
On bottom left, Severe diabetic macular edema with hemorrhage and fatty deposits.
On bottom right, optical coherence tomography (cross sectional scan showing cystic swelling in the retina)
- https://www.diabetes.org/in-my-community/local-offices/honolulu hawaii/?referrer=https://www.google.com/
- Diabetic Retinopathy Clinical Research Network, Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP, Antoszyk AN, Arnold-Bush B, Baker CW, Bressler NM, Browning DJ, Elman MJ, Ferris FL, Friedman SM, Melia M, Pieramici DJ, Sun JK, Beck RW. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. NEngl J Med. 2015 Mar 26;372(13):1193-203. doi: 10.1056/NEJMoa1414264. Epub 2015Feb 18. PubMed PMID: 25692915; PubMed Central PMCID: PMC4422053.
- Hendrick AM, Gibson MV, Kulshreshtha A. Diabetic Retinopathy. Prim Care. 2015 Sep;42(3):451-64. doi: 10.1016/j.pop.2015.05.005. Review. PubMed PMID: 26319349.