Abstract
Purpose :
To determine the outcomes of proliferative diabetic retinopathy (PDR) patients who are temporarily lost to follow-up (LTFU) immediately after receiving panretinal photocoagulation (PRP) versus intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF).
Methods :
A retrospective cohort study was performed of PDR patients between 9/23/13 and 4/20/17 who had either IVI with anti-VEGF or PRP on the visit before being LTFU for > 6 months. Charts were reviewed of those who met inclusion criteria for demographics, visual acuity (VA), intraocular pressure, hemoglobin A1c, and clinical findings. Change in continuous variables over time were assessed using the paired t-test. The independent t-test was used to compare continuous variables between treatment arms. Categorical outcomes were compared between the treatment arms using a chi-square test. Statistical significance was defined as p<0.05.
Results :
59 eyes met inclusion criteria, of which 32 had received only IVI of anti-VEGF and 27 had only received PRP prior to LTFU (Table 1). In the IVI group, mean logarithm of the minimum angle of resolution (logMAR) VA significantly worsened from the initial visit (0.62, Snellen 20/83) to the return visit (1.18, Snellen 20/300, p<0.001) and final visit (1.03, Snellen 20/210, p=0.02). In the PRP group, no significant difference in logMAR VA was found when comparing the initial visit (0.40, Snellen 20/50) to the return visit (0.64, Snellen 20/87, p=0.05) and final visit (0.57, Snellen 20/75, p=0.16). At the initial visit, one eye in each group had a traction retinal detachment (TRD). At the final visit, 7 eyes (21.9%) in the IVI group vs. 2 eyes (7.4%) in the PRP group had a TRD. At the initial visit, no eyes in the IVI group and one eye in the PRP group had neovascular glaucoma (NVG). At the final visit, 4 eyes (12.5%) in the IVI group vs. 1 eye (3.7%) in the PRP group had NVG.
Conclusions :
Patients with PDR who received only IVI of anti-VEGF prior to being lost to follow-up had worse outcomes on return compared to those who had received PRP. While the DRCR Network Protocol S demonstrated comparable outcomes in patients receiving either anti-VEGF or PRP, such results are contingent on timely follow-up. In real world clinical practice, loss to follow-up in eyes receiving only IVI may lead to worse outcomes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.