Abstract
Purpose :
Because the durability of anti-vascular endothial growth factor (VEGF) therapy is limited and patients with diabetes are prone to losses to follow-up, there is controversy regarding the role of anti-VEGF monotherapy in the treatment of ischemic diabetic retinopathy. We performed a retrospective, observational clinical study to investigate the consequences of inadvertent treatment interruptions in patients with diabetic retinopathy who are treated exclusively with anti-VEGF therapy.
Methods :
The study design was a retrospective, multi-center, observational case series. We identified patients treated exclusively with anti-VEGF therapy for proliferative (PDR) or non-proliferative diabetic retinopathy (NPDR), with or without diabetic macular edema (DME), and temporarily lost to follow-up. Baseline disease characteristics and treatment parameters, cause and duration of the treatment interruption, and resulting disease progression, complications, and outcomes were assessed by retrospective review of medical records.
Results :
Thirteen eyes of 12 patients with type 2 diabetes were identified. Mean age was 57 ± 10 years and 50% were women. Anti-VEGF therapy was indicated for PDR with DME in 7 (54%) eyes, PDR without DME in 3 (23%) eyes, and moderate to severe NPDR with DME in 3 (23%) eyes. Eight eyes had visual acuity (VA) of 20/80 or better prior to treatment interruption. Median duration of treatment hiatus was 12 months. Reasons for treatment interruption included intercurrent illness (31%), noncompliance (31%), and financial issues (15%). Complications upon follow-up included vitreous hemorrhage (9 eyes), neovascular glaucoma (5 eyes), and traction retinal detachment (4 eyes). Despite treatment of these complications, 77% of eyes lost ≥3 lines of VA, with 46% of eyes having a final VA of hand motion or worse.
Conclusions :
Diabetic patients are subject to significant lapses in follow-up because of illness, financial hardship, and/or noncompliance. In patients with diabetic retinopathy, especially proliferative disease, managed with anti-VEGF therapy alone, unintentional treatment interruptions can result in visually disastrous consequences, including irreversible blindness.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.