Challenges in the Clinical Management of Proliferative Diabetic Retinopathy: Treatment Choice and Follow-up
The last decade has witnessed an evolving debate over the best treatment for eyes with proliferative diabetic retinopathy (PDR). Both intravitreal anti–vascular endothelial growth factor (VEGF) therapy and panretinal photocoagulation are highly effective at treating PDR. Each of these approaches result in regression of retinal neovascularization and decreased risk of vision loss from PDR. However, treatment of patients with PDR is complicated by the fact that these individuals frequently have other systemic comorbidities and are at high risk of noncompliance with follow-up and other management recommendations. Previous reports have described poor outcomes in patients who have been treated solely with anti-VEGF and then experienced disease recurrence and worsening while lost to follow-up for extended periods of time. These cases have led some physicians to shy away from using anti-VEGF asmonotherapy, especially if concerns arise regarding a patient's future compliance with visits.
Tsui et al address the issue of whether there is an association between loss to follow-up or treatment approach with future likelihood of poor outcomes by performing a nested case-control study of a medical claims database. The authors examined the association of different types of prior treatment for PDR and a history of 6-month period of loss to follow-up with development of tractional retinal detachment (TRD). In this study, patients with PDR who progressed to TRD were matched with patients with PDR without TRD based on similar diagnosis year of PDR and inclusion criteria as of the index date. Tsui et al performed conditional logistic regression models for TRD with adjustment for several covariates and reported there was no difference in the odds of developing TRD between patients with vs without a history of a 6-month or greater period of loss to follow-up and between patients who received laser only vs those who received anti-VEGF injections only.
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