Causes and Clinical Impact of Loss to Follow-Up in Patients with Proliferative Diabetic Retinopathy

Purpose. This study determined the clinical impact and causes of loss to follow-up (LTFU) from the patients’ perspective in individuals with proliferative diabetic retinopathy (PDR) who received panretinal photocoagulation (PRP) and/or intravitreal injections (IVIs) of antivascular endothelial growth factor (VEGF). Methods. This prospective cohort study included 467 patients with PDR who received PRP and/or IVIs of anti-VEGF between May 2013 and June 2018. LTFU was defined as missing any follow-up visit for any interval exceeding 6 months, provided that patients eventually resumed care. Main outcome measures include rates and causes of LTFU. Results. A total of 391 patients (83.7%) were followed up, and 76 patients (16.3%) were LTFU over the study period. Rates of LTFU decreased with age (P=0.005). Questionnaire analysis conducted for patients’ LTFU showed a significant positive correlation between best corrected visual activity (BCVA) loss and patient’s lack of trust and satisfaction with treatment (rs = 0.458, P<0.001). There was also a significant positive correlation between treatment unaffordability and number of IVIs of anti-VEGF (rs = 0.55, P<0.001) and lack of social support and age (rs = 0.39, P<0.001). Conclusions. LTFU threatens vision in PDR patients receiving PRP and/or IVIs of anti-VEGF. Possibly, patient-specific LTFU causes should be addressed before treatment in order to minimize the risk of LTFU. The clinical trial is registered with NCT04018326 (trial registration: ClinicalTrials.gov Identifier: NCT04018326, 10th of July 2019 “Retrospectively registered”).

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Loss to Follow-Up in Patients with Proliferative Diabetic Retinopathy after Panretinal Photocoagulation or Intravitreal Anti-VEGF Injections

Ophthalmology ◽

10.1016/j.ophtha.2018.02.034 ◽

2018 ◽

Vol 125 (9) ◽

pp. 1386-1392 ◽

Cited By ~ 29

Author(s):

Anthony Obeid ◽

Xinxiao Gao ◽

Ferhina S. Ali ◽

Katherine E. Talcott ◽

Christopher M. Aderman ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Panretinal Photocoagulation ◽

Loss To Follow Up ◽

Anti Vegf

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Loss to Follow-Up Among Patients With Proliferative Diabetic Retinopathy in Clinical Practice

American Journal of Ophthalmology ◽

10.1016/j.ajo.2020.03.011 ◽

2020 ◽

Vol 215 ◽

pp. 66-71 ◽

Cited By ~ 2

Author(s):

Rishi Suresh ◽

Hannah J. Yu ◽

Alec Thoveson ◽

Jeremy Swisher ◽

Michael Apolinario ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Clinical Practice ◽

Proliferative Diabetic Retinopathy ◽

Loss To Follow Up

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Justification of optimal period for vitreoretinal intervention on the background of preoperative anti-VEGF therapy for proliferative diabetic retinopathy

POINT OF VIEW EAST – WEST ◽

10.25276/2410-1257-2020-3-13-15 ◽

2020 ◽

pp. 13-15

Author(s):

M.M. Bikbov ◽

◽

M.R. Kalanov ◽

T.R. Gilmanshin ◽

R.M. Zainullin ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Anti Vegf ◽

Optimal Period

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Renal Injury Following Intravitreal Anti-VEGF Administration in Diabetic Patients with Proliferative Diabetic Retinopathy and Chronic Kidney Disease - A Possible Side Effect?

Current Drug Safety ◽

10.2174/1574886309666140211113635 ◽

2014 ◽

Vol 9 (2) ◽

pp. 156-158 ◽

Cited By ~ 20

Author(s):

Ilias Georgalas ◽

Dimitris Papaconstantinou ◽

Kostas Papadopoulos ◽

Dionisis Pagoulatos ◽

Dimitris Karagiannis ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Diabetic Retinopathy ◽

Kidney Disease ◽

Proliferative Diabetic Retinopathy ◽

Renal Injury ◽

Side Effect ◽

Diabetic Patients ◽

Anti Vegf

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Observational outcomes in proliferative diabetic retinopathy patients following treatment with ranibizumab, panretinal laser photocoagulation or combination therapy – The non‐interventional second year follow‐up to the PRIDE study

Acta Ophthalmologica ◽

10.1111/aos.14907 ◽

2021 ◽

Author(s):

Gabriele E. Lang ◽

Andreas Stahl ◽

Jessica Voegeler ◽

Claudia Quiering ◽

Laureen Zaremba ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Combination Therapy ◽

Proliferative Diabetic Retinopathy ◽

Laser Photocoagulation ◽

Second Year ◽

Pride Study

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Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature

Pharmaceutics ◽

10.3390/pharmaceutics13081137 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1137

Author(s):

Irini Chatziralli ◽

Anat Loewenstein

Keyword(s):

Diabetic Retinopathy ◽

Vitreous Hemorrhage ◽

Fundus Photography ◽

Panretinal Photocoagulation ◽

Wide Field ◽

Vascular Endothelial ◽

Keywords Diabetic Retinopathy ◽

Anti Vegf ◽

The Impact

Background: Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population. The purpose of this review is to gather the existing literature regarding the use of the approved anti-vascular endothelial growth (anti-VEGF) agents in the treatment of DR. Methods: A comprehensive literature review in PubMed engine search was performed for articles written in English language up to 1 July 2021, using the keywords “diabetic retinopathy”, “ranibizumab”, “aflibercept”, and “anti-VEGF”. Emphasis was given on pivotal trials and recent robust studies. Results: Intravitreal anti-VEGF agents have been found to significantly improve visual acuity and reduce retinal thickness in patients with diabetic macular edema (DME) in a long-term follow-up ranging from 1 to 5 years and are considered the standard-of-care in such patients. Regarding DR, intravitreal anti-VEGF agents provided ≥2-step improvement in DR severity on color fundus photography in about 30–35% of patients with NPDR at baseline, in the majority of clinical trials originally designed to evaluate the efficacy of intravitreal anti-VEGF agents in patients with DME. Protocol S and CLARITY study have firstly reported that intravitreal anti-VEGF agents are non-inferior to panretinal photocoagulation (PRP) in patients with proliferative DR (PDR). However, the use of new imaging modalities, such as optical coherence tomography-angiography and wide-field fluorescein angiography, reveals conflicting results about the impact of anti-VEGF agents on the regression of retinal non-perfusion in patients with DR. Furthermore, one should consider the high “loss to follow-up” rate and its devastating consequences especially in patients with PDR, when deciding to treat the latter with intravitreal anti-VEGF agents alone compared to PRP. In patients with PDR, combination of treatment of intravitreal anti-VEGF agents and PRP has been also supported. Moreover, in the specific case of vitreous hemorrhage or tractional retinal detachment as complications of PDR, intravitreal anti-VEGF agents have been found to be beneficial as an adjunct to pars plana vitrectomy (PPV), most commonly given 3–7 days before PPV, offering reduction in the recurrence of vitreous hemorrhage. Conclusions: There is no general consensus regarding the use of intravitreal anti-VEGF agents in patients with DR. Although anti-VEGF agents are the gold standard in the treatment of DME and seem to improve DR severity, challenges in their use exist and should be taken into account in the decision of treatment, based on an individualized approach.

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Treatment of cystoid macular edema in a patient with primary open angle glaucoma and diabetic retinopathy by withdrawal of travoprost

IP International Journal of Ocular Oncology and Oculoplasty ◽

10.18231/j.ijooo.2021.035 ◽

2021 ◽

Vol 7 (2) ◽

pp. 180-183

Author(s):

Shiv Sagar N ◽

BN Kalpana ◽

Shilpa YD

Keyword(s):

Diabetic Retinopathy ◽

Macular Edema ◽

Laser Treatment ◽

Proliferative Diabetic Retinopathy ◽

Cystoid Macular Edema ◽

Open Angle Glaucoma ◽

Eye Drops ◽

Antiglaucoma Medication ◽

Micropulse Laser

To study the association of cystoid macular edema (CME) and Travoprost eye drops in a patient with diabetic retinopathy (DR).The study was carried out on a 65yr old patient on a regular follow up from 2009-2018.A 65yr old patient of a DR of both eyes who had received 3 sittings of pan retinal photocoagulation (PRP) laser in both eyes and grid laser to his right eye. He was on regular follow up since 2009 with a stable proliferative diabetic retinopathy (PDR). Patient was also on topical antiglaucoma medication and had prophylactic YAG-PI done both eyes. He was on regular follow up since 2009 with a stable proliferative diabetic retinopathy (PDR). Right eye showed macular edema (ME) in 2014 and underwent OCT and FFA. Patient refused for intravitreal injection and preferred laser treatment, so patient underwent micropulse laser treatment in 2014. His edema persisted even after micropulse treatment. His systemic control was good and patient continued to use Travoprost eye drops. So in 2017 suspected CME secondary to topical prostaglandin (PG) analogue as he had strict glycemic control and was no fluctuation in ME. Hence topical PG analogue was withdrawn and stopped. On subsequent follow up after 2 months CME had completely disappeared and the foveal contour returned to normal on OCT. LE was status quo. Patient was followed up for more than 1 year and continuously followed up, 15 days back in June 2018 had no evidence of CME and vision was 6/9 in both eyes.: Differentiation of DME and CME secondary to PG analogue should be made at the earliest.

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The role of anti-vascular endothelial growth factor (anti-VEGF) in the management of proliferative diabetic retinopathy

Drugs in Context ◽

10.7573/dic.212532 ◽

2018 ◽

Vol 7 ◽

pp. 1-10 ◽

Cited By ~ 26

Author(s):

Yue Zhao ◽

Rishi P Singh

Keyword(s):

Vascular Endothelial Growth Factor ◽

Diabetic Retinopathy ◽

Growth Factor ◽

Proliferative Diabetic Retinopathy ◽

Vascular Endothelial ◽

Anti Vegf ◽

Endothelial Growth Factor

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Endolaserless Vitrectomy With Intravitreal Aflibercept Injection for Proliferative Diabetic Retinopathy-Related Vitreous Hemorrhage (LASER LESS TRIAL)

Journal of VitreoRetinal Diseases ◽

10.1177/2474126418764972 ◽

2018 ◽

Vol 2 (3) ◽

pp. 127-137

Author(s):

Dennis M. Marcus ◽

Harinderjit Singh ◽

Davis C. Starnes ◽

Harveen Walia ◽

Amina Farooq ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Vitreous Hemorrhage ◽

Panretinal Photocoagulation ◽

Short Term ◽

Safety And Efficacy ◽

Intravitreal Aflibercept ◽

Central Subfield Thickness ◽

Endothelial Growth Factor

Purpose: For proliferative diabetic retinopathy (PDR) eyes not requiring vitrectomy, Diabetic Retinopathy Clinical Research Protocol S and the CLARITY trial demonstrated better visual function and anatomical outcomes with less proliferative and diabetic macular edema consequences in the antivascular endothelial growth factor groups compared to the panretinal photocoagulation groups. Intravitreal aflibercept injection (IAI) may represent a useful therapy with vitrectomy for PDR-related vitreous hemorrhage (VH) as a viable alternative to intraoperative endolaser during vitrectomy. We will determine the safety and efficacy when aflibercept is used for PDR-related VH with endolaserless vitrectomy. Methods: Evaluation of endolaserless vitrectomy and 2 mg IAI for PDR-related VH. Eyes receive 1 preoperative and intraoperative IAI followed by randomization to a q8week group receiving 4 postoperative q4week IAI followed by q8week IAI or q16week group receiving 2 postoperative q4week IAI followed by q16week IAI. Main Outcome Measures: Herein, we present pooled safety and efficacy outcomes through 4 months. Results: Twenty-one of 24 eyes were randomized. Preoperative average visual acuity (VA) was 36 letters (20/200). At 4-month follow-up, 18 of 21 randomized eyes showed an average VA of 72 letters (20/40) with an average visual gain of 38 (range, 0-84 gain) letters. Average optical coherence tomography (OCT) central subfield thickness (CST) at 1-month postoperative follow-up was 311 µm. Average OCT CST at 4-month follow-up was 272 µm (average thinning of 38 µm). No significant short-term ocular or systemic adverse events were observed through 4 months. Conclusions: Endolaserless vitrectomy with IAI for PDR-related VH demonstrates short-term safety with significant VA improvement.

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