Diabetes is reaching epidemic proportions in the United States with more then 26 million Americans currently suffering with this serious disease. The most common of the eye complications are bleeding in the retina and macular swelling. Diabetic retinopathy is the leading cause of blindness in young Americans, and the swelling of the retina is due to chronic, long term retinal inflammation.
In an attempt to treat this very serious inflammatory condition, steroid injections have been given directly into the affected eye. It should be noted that this therapeutic modality in not FDA approved, but doctors have continued to employ it since it has been effective in reducing the swelling. The problem has long been that this treatment has substantially increased risk of ocular complications. In addition, frequent injections every few months are required in order for the therapy to be effective.
The steroid injections reduce retinal thickness thus improving vision. The steroids inhibit this inflammation by suppressing the endothelial growth factor. This in turn decreases the vascular damage. These beneficial results only last about 3 months, but the potential side effects include cataracts, increased pressure in the eye, endophthalmitis (severe inflammation) and uveitis.
The goal is to increase the effectiveness of the steroid without increasing the negative side effects. Intraocular implants have been employed near the front of the eye, behind the natural lens, for treating multiple retinal conditions. These include cytomegalovirus (CMV) and posterior retinitis. These implants require sutures and thus have an increased risk of infection when used.
Iluvien is an injectable steroid that is currently under FDA investigation for Diabetic Macular Edema and will last up to 3 years after injection. It is injected with a 25 gauge needle which seals itself; not requiring any sutures. It can also be placed more posterior in the eye for higher effectively and thus better results; this will also decrease the chances of bad side effects so common with the other steroid injections.
This article is written by Dr. Jay Stockman, contributing consultant to
Vision Update. Dr. Jay Stockman has co-managed a significant number of refractive surgery patients. Advise, and medical questions can be directed to
New York Vision Associates
