Clinical Practice Patterns of Intravitreal Anti-Vascular Endothelial Growth Factor Injections in Treatment of Patients with Diabetic Macular Edema: A Retrospective Study

Abstract

Purpose : The first line treatment for center-involved diabetic macular edema (CI-DME) utilizes anti-vascular endothelial growth factor (VEGF) drugs. The ophthalmologic community remains disputed regarding an optimized approach as to the choice, number, and frequency intervals of intravitreal injections for best visual outcome. This retrospective study investigates the clinical practice patterns of retinal providers using anti-VEGF therapy on visual outcome in DME patients.

Methods : EPIC EMR was used to identify 185 clinically diagnosed DME eyes of 131 subjects (18-100 years) that were seen between 2010-2020 by any of the four retina specialists practicing in a single hospital-based center at University of Texas Medical Branch. The subjects received either Bevacizumab, Aflibercept, or Ranibizumab for DME treatment. The number, interval, and total length of injection treatment were recorded for each provider. Eyes treated by only the same provider were included. First achieved visual acuity (VA) of 20/30 was used to quantify efficacious treatment, and all data was assessed using Chi-square and Krustkal-Wallis tests.

Results : Identified DME patients (age 61.6 yrs), primarily in Caucasians (67%) with no gender difference, had increased propensity of hyperlipidemia and chronic kidney disease (75% and 51% respectively). Among providers, there was a significant difference in the median number of injections (3-8, p=0.0002) and in the time interval between the first and last injections (83-296 days; p=0.0015) per eye. However, providers were similar in the average intervals between injections (30-40 days; p=0.38). Although VA improved pre- and post-treatment amongst providers, there was no significant difference in improvement when comparing the providers. Bevacizumab was the most common choice of anti-VEGF for all four providers (p=0.23) followed by Aflibercept (p=0.27). When compared to other anti-VEGF drugs, Aflibercept resulted in significantly better visual outcome (p=0.001).

Conclusions : Our results show a consensus of monthly use of injections for improved vision despite differences among providers in the frequency and total length of injections. Aflibercept has better visual outcome among all the providers. Further studies are needed to establish an algorithm to institute a “benchmark” protocol for retina physicians in managing DME.

This is a 2021 ARVO Annual Meeting abstract.