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JOHN W HINKLE, Raziyeh Mahmoudzadeh, Rachel Israilevich, Mirataollah Salabati, Anthony Obeid, Jason Hsu, Sunir J. Garg; Outcomes In Eyes Lost to Follow-up After Treatment with Steroid Injections for Retinal Pathology. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3302.
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To evaluate the effect of loss to follow-up (LTFU) on eyes treated with intraocular and periocular steroid injections.
Patients receiving intraocular or periocular steroid injections for retinal diseases and who were subsequently LTFU for at least 180 days after injection were included. Charts were reviewed for visual acuity (VA), intraocular pressure (IOP), and central foveal thickness (CFT) at the treatment visit before LTFU, the first return visit, and visits 3, 6, and 12 months later.
Fifty-three eyes of 47 patients were identified. Mean age was 62.3 years, mean LTFU duration was 295 days, and mean follow-up period after returning was 392 days. Indications for steroid injections were: uveitis-associated cystoid macular edema (CME) 23/53 (43.5%) , diabetic macular edema (DME) 13/53 (24.5%), post-surgical CME 13/53 (24.5%), and retinal vein occlusion (RVO) 4/53 (7.5%). The injection preceding LTFU was peri-ocular triamcinolone in 31/53 (58%) eyes and intravitreal steroid in 22 of 53 eyes (42%) (dexamethasone intravitreal implant in 15/53 (28%) and triamcinolone in 7/53 (14%)). Compared to mean VA prior to LTFU [0.59, Snellen ~20/77], the mean VA was not significantly different at each time point after return (first return visit [0.62, Snellen ~20/83, p=0.6], month 3 [0.55, Snellen ~20/70, p=0.6], month 6 [0.55, Snellen ~20/70, p=0.5], month 12 [0.64, Snellen ~20/87, p=0.6].Overall, at all return visits, there was a slight increase in IOP. At the first return visit, 8/53 (15%) had IOP ≥ 21 mmHg (range= 8-31) but only 2 patients required treatment with a single new anti-hypertensive medication. No patient required glaucoma surgery. The DME group showed greater mean IOP at first return visit [17.45 mmHg, p=0.04] and at 12 month after return [20.25 (5.2), p=0.02] compared to before LTFU (13.76 mmHg). CFT increased after return visit (392 mm) compared to prior to LTFU (369 mm, p=0.35). The mean CFT declined significantly by month 6 [294 mm, p=0.005] and month 12 [269 mm, p<0.001].
Eyes LTFU after receiving steroid injections did not experience signfiicant morbidity. Mean VA, IOP, and CFT were not significantly worse immediately after LTFU and 12 months later, though patients with DME did experience a more significant increase in IOP.
This is a 2021 ARVO Annual Meeting abstract.
Visual acuity in eyes lost to follow up after steroid injection
Intraocular pressure in eyes lost to follow up after steroid injection
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