Outcomes of Eyes Lost to Follow-up with Proliferative Diabetic Retinopathy That Received Panretinal Photocoagulation versus Intravitreal Anti–Vascular Endothelial Growth Factor

Obeid, Anthony; Su, Daniel; Patel, Samir N.; Uhr, Joshua H.; Borkar, Durga S.; Gao, Xinxiao; Fineman, Mitchell S.; Regillo, Carl D.; Maguire, Joseph I.; Garg, Sunir J.; Hsu, Jason

doi:10.1016/j.ophtha.2018.07.027

Cited by 130 publications

(136 citation statements)

References 17 publications

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“…Most patients with DR, who were lost to follow-up, had no subsequent follow-up after 6 (74.6%) or 12 months (83.5%). In the studies conducted by Obeid et al [4,14], the insurance status of patients was not documented, and the expense of treatment and follow-up examinations may have greatly influenced the adherence to treatment.…”

Section: Discussionmentioning

confidence: 99%

Treatment compliance and adherence among patients with diabetic retinopathy and age-related macular degeneration treated by anti-vascular endothelial growth factor under universal health coverage

Angermann

Rauchegger

Nowosielski

et al. 2019

Graefes Arch Clin Exp Ophthalmol

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Purpose To analyze and compare loss to follow-up (LTFU) rates between patients with diabetic retinopathy (DR) and those with neovascular age-related macular degeneration (nAMD) in patients, receiving treatment with anti-vascular endothelial growth factor (VEGF), under universal health coverage. Methods We retrospectively analyzed the relevant data of 1264 patients receiving anti-VEGF therapy, in this cohort study. The observation period ranged from September 01, 2015 to December 31, 2018. Intervals between each procedure and the subsequent follow-up examination were measured. Demographic data, visual acuity (VA), the type of transport for treatment access, and distance between the residence and clinic were evaluated as risk factors for LTFU. Results We collected data for 841 patients with nAMD (age, 81.0 (± 8.1 years)) and 423 patients with DR (age, 67.7 (± 12.1 years)). The rate of LTFU, for at least 6 months, was 28.8% and 2.9% for patients with DR and nAMD, respectively (p < 0.001). In the DR group, 18.9% patients were lost to follow-up exceeding > 12 months. Multivariate regression analysis showed that advanced age, lack of mobility, and need for assisted transport, poor final VA despite treatment, and decrease in vision during the observational period were independent risk factors for LTFU exceeding 12 months (p < 0.05). Conclusions We found a high long-term LTFU rate for patients with DR, despite treatment under universal health coverage. Considering the risk of disease progression, particularly in patients with chronic DR, strategies for better compliance and adherence to therapy should be considered for optimized patient care.

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Section: Discussionmentioning

confidence: 99%

Treatment compliance and adherence among patients with diabetic retinopathy and age-related macular degeneration treated by anti-vascular endothelial growth factor under universal health coverage

Angermann

Rauchegger

Nowosielski

et al. 2019

Graefes Arch Clin Exp Ophthalmol

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“…Diabetic patients are prone to significant loss to follow up due to illness, financial hardship, and lack of compliance. The rate of complications and loss of vision after unintentional interruptions for more than 6 months in PDR patients treated only on anti-VEGF was considerably higher than the eyes that received PRP, with a significantly higher number of eyes with tractional retinal detachment and neovascularization of the iris [102]. In a retrospective review of 13 eyes treated exclusively with anti-VEGF for PDR with or without macular edema or severe NPDR with macular edema, with hiatus of 12 months, 9 presented with vitreous hemorrhage, 5 with neovascular glaucoma, and 4 with tractional retinal detachment.…”

Section: Management Of Proliferative Diseasementioning

confidence: 81%

Diabetic Retinopathy and Blindness: An Epidemiological Overview

Pandova¹

2020

Visual Impairment and Blindness - What We Know and What We Have to Know

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Prevalence of diabetes is rising worldwide. In the course of the last 20 years, blindness and low vision due to diabetic eye complications have increased in large regions in Eastern Europe, North Africa/Middle East, Asia, Latin America, and Oceania. The magnitude and trends of vision-threatening disease are presented. Systemic risk factors for progression to sight-threatening disease are reviewed. The impact of economic and cultural background on early diagnosis and adherence to treatment is highlighted. Current management of diabetic macular edema, proliferative diabetic retinopathy, neovascular glaucoma, and cataract surgery of diabetic patients is outlined, and its contribution to preventing vision loss is reviewed.

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“…Another retrospective cohort study (Obeid et al, 2018), with 2303 patients enrolled, reported a higher rate of loss to follow-up (LTFU) in PRP group, which may be explained by its more durable effect, higher pain level (Lucena CRF de et al, 2013) and some complications. Obeid et al, 2019(Obeid et al, 2019 further investigated 59 PDR patients who were LTFU for over 6 months, in which anti-VEGF monotherapy manifested worse anatomic and functional outcomes. Wei et al (2017) also reported that fibronectin and fibrinogen concentrations in vitreous humor of intravitreal anti-VEGF injection group, which might promote fibrosis in eyes with PDR.…”

Section: Discussionmentioning

confidence: 99%

Anti-Vascular Endothelial Growth Factor Therapy as an Alternative or Adjunct to Pan-Retinal Photocoagulation in Treating Proliferative Diabetic Retinopathy: Meta-Analysis of Randomized Trials

2020

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Aim: To compare anti-vascular growth factor (anti-VEGF) pharmacotherapy with panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR). Method: PubMed, Embase, Medline, the ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials were reviewed systemically. Randomized controlled trials (RCT) on anti-VEGF therapy versus PRP or anti-VEGF agent combined with PRP versus PRP for PDR are eligible to be included. Outcome measures were regression and recurrence of neovascularization, change in best corrected vision acuity, development of vitreous hemorrhage, and need for vitrectomy. A meta-analysis was conducted using RevMan (Cochrane Collaboration, Oxford, United Kingdom). Results: Twelve RCTs with a total of 1026 eyes were identified. The meta-analysis results showed that regression of neovascularization did not vary significantly among different treatment regimens (P=0.06), whereas the recurrence of new vessels was significantly lower in PRP monotherapy (P < 0.00001). The best corrected visual acuity was significantly improved with anti-VEGF monotherapy or in the combined group than in the PRP groups (P < 0.00001, P=0.04, respectively). Odds ratio for post-treatment vitreous hemorrhage and vitrectomy rate between anti-VEGF therapy and PRP were 0.65 (95% confidence interval, 0.45-0.95; P = 0.03), and 0.24 (95% confidence interval, 0.12-0.48; P < 0.0001). Conclusion: Our meta-analysis indicates that anti-VEGF pharmacotherapy is associated with superior visual acuity outcomes and less PDR-related complications. However, there is insufficient evidence to suggest anti-VEGF therapy as an alternative to PRP.

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Outcomes of Eyes Lost to Follow-up with Proliferative Diabetic Retinopathy That Received Panretinal Photocoagulation versus Intravitreal Anti–Vascular Endothelial Growth Factor

Abstract: Eyes with PDR that received only intravitreal anti-VEGF demonstrated worse anatomic and functional outcomes after being LTFU compared with eyes that received PRP. Given the potential sequelae of being LTFU, the choice of treatment for PDR must be considered carefully.

Cited by 130 publications

References 17 publications

Treatment compliance and adherence among patients with diabetic retinopathy and age-related macular degeneration treated by anti-vascular endothelial growth factor under universal health coverage

Treatment compliance and adherence among patients with diabetic retinopathy and age-related macular degeneration treated by anti-vascular endothelial growth factor under universal health coverage

Diabetic Retinopathy and Blindness: An Epidemiological Overview

Anti-Vascular Endothelial Growth Factor Therapy as an Alternative or Adjunct to Pan-Retinal Photocoagulation in Treating Proliferative Diabetic Retinopathy: Meta-Analysis of Randomized Trials

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