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Bryce Hwang, Amee D Azad, Evan Chen, Nadim Rayess, JOHN W HINKLE, Ravi Parikh, Prithvi Mruthyunjaya; Vitrectomy after Anti-VEGF or Pan-retinal Photocoagulation Therapy in Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2202 – F0265.
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The Protocol S trial compared ranibizumab with PRP and found that treatment with ranibizumab leads to fewer vitrectomy procedures. The purpose of this study is to characterize the odds of pars plana vitrectomy (PPV) after pan-retinal photocoagulation (PRP) or anti-vascular endothelial growth factor (anti-VEGF) injections in the treatment of proliferative diabetic retinopathy (PDR).
A retrospective cross-sectional study from January 1, 2012 to December 31, 2017 was conducted using a nationally representative claims-based database, Clinformatics™ Data Mart Database (OptumInsight, Eden Prairie, MN). Newly diagnosed, treatment naïve adults (≥ 18 years old) with PDR as defined by ICD9/10 codes and continuous enrollment for at least two years after diagnosis were included. CPT codes were used to determine PDR therapy and PPV status. Eyes were analyzed separately and were stratified into two groups: eyes receiving only anti-VEGF therapy (anti-VEGF group) and eyes treated with PRP monotherapy (PRP group). Primary outcomes were rates of PPV and median time to PPV for each group.
The cohort consisted of 2368 eyes with PDR. Overall, 52.8% of patients were male with a median age of 65 (54-71). Of these, 1787 eyes were treated with PRP only, and 581 were treated with anti-VEGF only. 3.4% (20/581) and 4.9% (87/1787) of eyes required PPV in the anti-VEGF and PRP groups respectively (p=0.150). Median time to PPV was 114 days and 188 days in the anti-VEGF and PRP groups respectively (p=0.079). Adjusted for gender and age, the odds of vitrectomy were not different between eyes treated with PRP only compared to those treated with anti-VEGF only (odds ratio [OR] 1.14, CI 0.69-1.96, p=0.629).
This study examines eyes with PDR treated with either anti-VEGF monotherapy or PRP monotherapy to determine the likelihood of vitrectomy in a large, nationally representative cohort. Although median time to vitrectomy was longer for anti-VEGF monotherapy compared to PRP monotherapy, both treatment modalities had the same odds of ultimately requiring a vitrectomy. These results suggest that PRP does not increase the odds of vitrectomy compared to anti-VEGF in PDR patients. The implications for clinical practice and patient counseling should be further explored.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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