Gao Xinxiao, Obeid Anthony, Aderman Christopher M, Talcott Katherine E, Ali Ferhina S, Adam Murtaza K, Rovner Barry W, Hyman Leslie, Ho Allen C, Hsu Jason
Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania.
Ophthalmol Retina. 2019 Mar;3(3):230-236. doi: 10.1016/j.oret.2018.11.002. Epub 2018 Nov 10.
To determine the rate of loss to follow-up (LTFU) and associated risk factors in patients with nonproliferative diabetic retinopathy (NPDR) who had diabetic macular edema (DME) and were receiving intravitreal anti-vascular endothelial growth factor (VEGF) injections.
Retrospective cohort study.
A total of 2595 NPDR patients with DME who received at least one anti-VEGF injection at a single large retina practice from January 1, 2012, to January 1, 2017.
A retrospective review based on billing codes was performed. LTFU was defined as no subsequent office visits within 12 months after an intravitreal injection. Patient demographics and clinical features were evaluated, and logistic regression was used to identify independent predictors for LTFU.
LTFU rates and potential risk factors.
LTFU was found in 413 (25.3%) of 1632 patients. Examining LTFU by racial groups, 21.3% identified themselves as white, 29.1% as black, 30.6% as Asian, and 35.0% as Hispanic (P < 0.001). A difference in LTFU was also found based on average adjusted gross income (AGI) (P < 0.001) and NPDR stage (P = 0.04). In the multivariate model, factors associated with LTFU included Hispanic (odds ratio [OR] 1.66), American Indian, Pacific Islander, multiple races (OR 2.60), and unknown race (OR 1.59) compared with those who were white. Additional factors included those with an average AGI of $50000 to $75000 (OR 1.37) and <$50000 (OR 1.88) compared with those with an average AGI > $75000. Based on subgroup analysis of patients with available visual acuity data, a significant association was found between decreasing baseline vision and LTFU (P < 0.001).
Approximately 1 in 4 patients with NPDR who had DME had no follow-up visit for at least 1 year after an anti-VEGF injection. Given the importance of ongoing therapy, these real-world findings may help identify at-risk groups for noncompliance with care.
确定患有糖尿病性黄斑水肿（DME）且正在接受玻璃体内抗血管内皮生长因子（VEGF）注射的非增殖性糖尿病视网膜病变（NPDR）患者的失访率（LTFU）及相关危险因素。
回顾性队列研究。
2012年1月1日至2017年1月1日期间，在一家大型视网膜诊所接受至少一次抗VEGF注射的2595例患有DME的NPDR患者。
基于计费代码进行回顾性分析。LTFU定义为玻璃体内注射后12个月内无后续门诊就诊。评估患者的人口统计学和临床特征，并使用逻辑回归确定LTFU的独立预测因素。
LTFU率和潜在危险因素。
在1632例患者中，有413例（25.3%）出现LTFU。按种族分组检查LTFU情况，21.3%的患者自认为是白人，29.1%是黑人，30.6%是亚洲人，35.0%是西班牙裔（P<0.001）。基于平均调整后总收入（AGI）（P<0.001）和NPDR分期（P=0.04）也发现了LTFU的差异。在多变量模型中，与LTFU相关的因素包括西班牙裔（比值比[OR]1.66）、美国印第安人、太平洋岛民、多种族（OR 2.60）以及与白人相比种族未知（OR 1.59）的患者。其他因素包括平均AGI为50000至75000美元的患者（OR 1.37）以及与平均AGI>75000美元的患者相比AGI<50000美元的患者（OR 1.88）。根据对有可用视力数据患者进行的亚组分析，发现基线视力下降与LTFU之间存在显著关联（P<0.001）。
患有DME的NPDR患者中，约四分之一在接受抗VEGF注射后至少1年没有进行随访。鉴于持续治疗的重要性，这些实际研究结果可能有助于识别不遵守治疗的高危人群。
