A novel intravitreal fluocinolone acetonide implant (Iluvien(®)) in the treatment of patients with chronic diabetic macular edema that is insufficiently responsive to other medical treatment options: a case series.

BACKGROUND
Iluvien (®) is a novel, nonbiodegradable, sustained-release drug delivery system (0.2 mg / d fluocinolone acetonide [FAC]) is indicated in Europe for the treatment of visual impairment associated with chronic diabetic macular edema (DME), considered to be less responsive to available therapies.


OBJECTIVE
To evaluate the safety and efficacy of FAC 190-mg implant in patients with chronic refractory DME other medical treatment options in clinical settings.


METHOD
Retrospective registry data was collected using a standard case report form (CRF). Prior to injection of intravitreal implant FAC, all patients were treated either with an antagonist of vascular endothelial growth factor (VEGF) and / or steroid (triamcinolone, dexamethasone implant). Patients were excluded from receiving FAC if they had a known history of an increase in intraocular pressure (IOP) after corticosteroid therapy, glaucoma, ocular hypertension, or contraindicated cited in the summary of product characteristics. Best-corrected visual acuity (BCVA) is the primary parameter studies. Central thickness of the fovea (CFT) and IOP was measured simultaneously. This parameter is recorded before and after injection of 190-mg implant FAC (between 1 week and 9 months). Injections carried out between May 2013 and March 2014.


RESULTS
Fifteen eyes of ten patients treated. Thirteen eyes (nine patients) were pseudophakic and seven eyes (five patients) vitrectomized before receiving treatment. BCVA improved in eleven eyes (73.3%), remained unchanged in two eyes (13.3%), and slightly decreased in the two eyes (13.3%) at the final follow-up visit to the elementary level. IOP increased in two patients and are controlled using a fixed-combination of IOP-lowering eyedrops or sectoral cyclocryotherapy (n = 1).


CONCLUSION
FAC 190-mg implant is efficacious and demonstrated favorable benefit-to-profile risk in a population of patients with chronic DME series of cases refractory to other therapy. Long-term Efficacy and safety in real-life settings is still being assessed at this center. FAC may offer important treatment option for patients with chronic refractory DME other treatment options.

 A novel intravitreal fluocinolone acetonide implant (Iluvien(®)) in the treatment of patients with chronic diabetic macular edema that is insufficiently responsive to other medical treatment options: a case series.
A novel intravitreal fluocinolone acetonide implant (Iluvien(®)) in the treatment of patients with chronic diabetic macular edema that is insufficiently responsive to other medical treatment options: a case series.

nanobeads magnetic decorated by thermo-responsive PNIPAM shell as a medical platform for the efficient delivery of doxorubicin to the tumor cells.

medical nanoplatforms based cluster superparamagnetic nanoparticles decorated with thermo-responsive PNIPAM shell has been synthesized and used as drug carriers for doxorubicin (DOXO), a common chemotherapeutic agent. The nanosystem here developed has an overall diameter below 200 nm and exploit temperature responsive behavior of PNIPAM shell polymers for controlled loading and release DOXO.

This system has been tested in vitro on tumor cells and it clearly demonstrates the effectiveness of the drug and polymer encapsulation time-dependent cell death caused by the release of doxorubicin. Mobile comparative studies of DOXO loaded nanoplatform the presence or absence of an external magnet (0.3 T) indicate a synergistic effect of accumulation and increased toxicity of the system, when magnetically guided, so that the enhanced efficacy of the system.

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Advances in medical treatment of various pathophysiological conditions require the development of better therapeutic agents, as well as combinations of therapeutic agents required by the integrated device biomaterials that can serve as sensors and operator. The combination of micro systems and nano-fabrication with intelligent biomaterials that have the ability to feel and response is a promising avenue for the development of better medical system diagnostic and therapeutic.