Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.
Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.
Am J Ophthalmol. 2019 Aug;204:13-18. doi: 10.1016/j.ajo.2019.03.005. Epub 2019 Mar 13.
To illustrate that patients with diabetic retinopathy who are treated exclusively with anti-vascular endothelial growth factor (VEGF) therapy and have an interruption in treatment may experience marked progression of disease with potentially devastating visual consequences.
Retrospective, multicenter, case series.
Retrospective review of patients treated exclusively with anti-VEGF therapy for proliferative diabetic retinopathy (PDR) or nonproliferative diabetic retinopathy (NPDR), with or without diabetic macular edema (DME), and temporarily lost to follow-up. Baseline disease characteristics, cause and duration of the treatment interruption, and resulting disease progression, complications, and outcomes were assessed.
Thirteen eyes of 12 patients with type 2 diabetes were identified. The mean age was 57 ± 10 years, and 50% were women. Anti-VEGF therapy was indicated for PDR with DME in 7 (54%) eyes, PDR without DME in 3 (23%) eyes, and moderate to severe NPDR with DME in 3 (23%) eyes. Eight eyes had visual acuity (VA) of 20/80 or better before treatment interruption. The median duration of treatment hiatus was 12 months. Reasons for treatment interruption included intercurrent illness (31%), noncompliance (31%), and financial issues (15%). Complications upon follow-up included vitreous hemorrhage (9 eyes), neovascular glaucoma (5 eyes), and traction retinal detachment (4 eyes). Despite treatment of these complications, 77% of eyes lost ≥3 lines of VA, with 46% of eyes having a final VA of hand motion or worse.
Diabetic patients are subject to significant lapses in follow-up because of illness, financial hardship, or noncompliance. In patients with diabetic retinopathy, especially PDR, who are managed with anti-VEGF therapy alone, unintentional treatment interruptions can result in irreversible blindness.
说明仅接受抗血管内皮生长因子（VEGF）治疗且治疗中断的糖尿病视网膜病变（DR）患者可能会出现疾病显著进展，从而导致潜在的严重视力损害。
回顾性、多中心、病例系列研究。
回顾性分析了因增生性糖尿病视网膜病变（PDR）或非增生性糖尿病视网膜病变（NPDR），伴或不伴糖尿病性黄斑水肿（DME）而接受单纯抗 VEGF 治疗，且暂时失访的患者。评估了基线疾病特征、治疗中断的原因和持续时间，以及由此导致的疾病进展、并发症和结局。
确定了 12 例 2 型糖尿病患者的 13 只眼。平均年龄为 57 ± 10 岁，女性占 50%。7 只眼（54%）接受抗 VEGF 治疗的原因为伴有 DME 的 PDR，3 只眼（23%）为无 DME 的 PDR，3 只眼（23%）为伴有 DME 的中重度 NPDR。治疗中断前，8 只眼的视力（VA）为 20/80 或更好。治疗中断的中位持续时间为 12 个月。治疗中断的原因包括并发疾病（31%）、不遵医嘱（31%）和经济问题（15%）。随访时出现的并发症包括玻璃体积血（9 只眼）、新生血管性青光眼（5 只眼）和牵引性视网膜脱离（4 只眼）。尽管对这些并发症进行了治疗，但仍有 77%的眼 VA 丧失≥3 行，46%的眼最终 VA 为手动或更差。
由于疾病、经济困难或不遵医嘱，糖尿病患者的随访存在明显的间断。在单独接受抗 VEGF 治疗的 DR 患者，尤其是 PDR 患者中，非故意的治疗中断可导致不可逆转的失明。
