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Xinxiao Gao, Anthony Obeid, Allen Ho, Jason Hsu; Loss of follow-up in patients with diabetic macular edema (DME) after prior intravitreal anti-vascular endothelial growth factor (VEGF) injections. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1918.
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Clinical trials have confirmed the benefit of intravitreal anti-VEGF injections for DME. More frequent dosing appears to optimize visual outcomes, especially in the first year of treatment. Since many DME patients are working aged adults, we sought to determine the drop-out rate of patients who previously received intravitreal injections for DME as well as associated demographic features.
A retrospective review based on billing codes was performed of all DME patients who received at least one intravitreal anti-VEGF injection at a single large retina practice from 4/1/12 to 12/1/16. Loss of follow-up was defined as no visits [JH1] in the 12 months prior to 12/1/16. Patient demographics were reviewed, including age, gender, and race/ethnicity. The number of cumulative intravitreal injections prior to the loss of follow-up was categorized into 3 groups (1-3, 4-10, >10 injections). The association between loss of follow-up and these features were evaluated using the chi-square test. Logistic regression was used to identify independent predictors for loss of follow-up.
A total of 2537 unique DME patients were included in this study. A loss of follow-up was found in 330 patients (13.0%). The loss of follow-up group was older on average [JH1] (71 years vs. 65 years, P<0.001) No significant difference was found based on race/ethnicity (P=0.593) or gender (P=0.956). In the 1-3 injection group, 196 of 894 patients (21.9%) were lost to follow-up; in the 4-10 injection group, 108 of 892 patients (12.1%) were lost to follow-up; and in the >10 injection group, 26 of 751 patients (3.5%) were lost to follow-up. The difference in proportion lost to follow-up when comparing each group was statistically significant (P<0.001[JH2] ). Age and number of injections were independent predictors of loss of follow-up.
A relatively large proportion of patients who received only 1-3 intravitreal injections for DME prior to 12/1/15 had no additional visits between 12/1/15 and 12/1/16. Further analysis looking at larger numbers of DME patients along with intervals between intravitreal injections and return visits will be necessary.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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