Shah Anjali R, Van Horn Adam N, Verchinina Lilia, Wichorek Michele, Su Lydia, Markel Dorene, Gardner Thomas W
Department of Ophthalmology, Kellogg Eye Center, and Michigan Medicine, Ann Arbor, Michigan.
Michigan State University College of Human Medicine, East Lansing, Michigan.
Ophthalmol Retina. 2019 May;3(5):410-416. doi: 10.1016/j.oret.2019.01.019. Epub 2019 Feb 2.
Intravitreal anti-vascular endothelial growth factor (VEGF) injections are used commonly in the treatment of diabetic retinopathy (DR), but the need for treatment and frequency of administration vary considerably among patients. There is no way to predict which patients will require treatment and how frequently injections will be needed. This study aimed to identify factors associated with receiving anti-VEGF injections and the number of treatments received in an 18-month period in patients with diabetes.
Retrospective cohort study.
Two thousand nine hundred sixteen patients with diabetes treated at the Kellogg Eye Center Retina Clinic from June 1, 2016, through December 31, 2017.
Retrospective analysis was performed with institutional review board approval using data collected from diabetic patients treated at the retina clinic at the Kellogg Eye Center. Logistic regression was used to identify demographic and medical factors associated with receiving at least 1 injection. Negative binomial regression was used to model the number of anti-VEGF injections.
Receiving at least 1 anti-VEGF injection and the number of anti-VEGF injections received during the study period.
Systolic blood pressure and a diagnosis of DR were associated significantly with receiving an injection. A history of kidney disease was associated positively with the number of injections received. Type 1 diabetes was associated negatively with receiving an injection and the number of injections. Current hemoglobin A1c level was not associated with either receiving an injection or the number of injections.
Elevated blood pressure is associated significantly with the need for treatment with anti-VEGF injections in patients with diabetes, and a diagnosis of type 1 diabetes is associated negatively with both receiving treatment and the number of injections. Of note, current glycemic control is not associated significantly with either outcome measure. To our knowledge, these associations have not been previously reported, and imply that factors that confer risk for DR development may not be the same that confer risk for treatment.
玻璃体内注射抗血管内皮生长因子（VEGF）常用于治疗糖尿病性视网膜病变（DR），但患者的治疗需求和给药频率差异很大。目前尚无办法预测哪些患者需要治疗以及需要多久注射一次。本研究旨在确定糖尿病患者在18个月内接受抗VEGF注射的相关因素以及接受治疗的次数。
回顾性队列研究。
2016年6月1日至2017年12月31日在凯洛格眼科中心视网膜诊所接受治疗的2916例糖尿病患者。
在机构审查委员会批准下进行回顾性分析，使用从凯洛格眼科中心视网膜诊所治疗的糖尿病患者收集的数据。采用逻辑回归确定与接受至少1次注射相关的人口统计学和医学因素。采用负二项回归对抗VEGF注射次数进行建模。
在研究期间接受至少1次抗VEGF注射以及接受抗VEGF注射的次数。
收缩压和DR诊断与接受注射显著相关。肾脏疾病史与接受注射的次数呈正相关。1型糖尿病与接受注射及注射次数呈负相关。当前糖化血红蛋白水平与接受注射或注射次数均无关。
血压升高与糖尿病患者抗VEGF注射治疗需求显著相关，1型糖尿病诊断与接受治疗及注射次数均呈负相关。值得注意的是，当前血糖控制与这两个观察指标均无显著关联。据我们所知，这些关联此前尚未见报道，这意味着导致DR发生风险的因素可能与导致治疗风险的因素不同。
