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Marc Ohlhausen, Carter Payne, Tyler E Greenlee, Thais Conti, Rishi P Singh; Delayed Panretinal Photocoagulation Treatment in Proliferative Diabetic Retinopathy and the Impact on Treatment Outcomes. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3823.
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© ARVO (1962-2015); The Authors (2016-present)
The American Academy of Ophthalmology recommends that patients diagnosed with proliferative diabetic retinopathy (PDR) be considered for panretinal photocoagulation (PRP) treatment within 1 month of diagnosis. Due to its long-lasting effects, PRP is especially important in the treatment of patients with a history of poor follow-up. We aimed to investigate which medical and socioeconomic factors contribute to delayed treatment of PDR, and what effect delayed treatment has on best corrected visual acuity (BCVA) outcomes.
This retrospective study examined 267 patients diagnosed with PDR and treated with PRP at the Cleveland Clinic, 2015 to present. Patients were excluded if non-PRP laser procedures were used to treat PDR. We examined the relationship between time to treatment (days from diagnosis to PRP) and medical comorbidities (coronary artery disease/myocardial infarction, heart failure, chronic kidney disease, dialysis, stroke, inpatient admission), laboratory values (hemoglobin A1c, blood urea nitrogen, serum creatinine), and socioeconomic factors (health insurance, median household income of home ZIP code, and distance from ZIP code to treatment site). BCVA outcomes at 12 months were compared between those who received treatment within 1 month and those who did not. Student’s t-test, ANOVA, and linear regression were used for statistical analysis.
Mean time to treatment for all patients was 42.6±103.6 days. Inpatient admission between diagnosis and treatment was the only factor significantly associated with an increase in time to treatment (+144.4 days, p=0.003). Dialysis was associated with a significant decrease in time to treatment (-22.8 days, p=0.035). No other factors were significant. Initial BCVA was similar between patients treated within 1 month and those treated after (65.4±22.4 vs. 66.6±22.2 ETDRS letters, p=0.693), but those treated within 1 month had significantly higher BCVA at 12 months (67.9±20.3 vs. 60.3±24.4 letters, p=0.048).
Inpatient admissions significantly increase time to PRP treatment for PDR, but the effect of other factors is unclear and warrants further study. Early treatment of PDR is important for maximizing visual outcomes.
This is a 2020 ARVO Annual Meeting abstract.
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