Outcomes of Eyes Lost to Follow-up with Proliferative Diabetic Retinopathy That Received Panretinal Photocoagulation versus Intravitreal Anti–Vascular Endothelial Growth Factor
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Purpose To compare anatomic and functional outcomes in eyes with proliferative diabetic retinopathy (PDR) that were lost to follow-up (LTFU) for more than 6 months after treatment with either intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) agents or panretinal photocoagulation (PRP).Design Retrospective cohort study.Participants Fifty-nine patients who were LTFU immediately after treatment for more than 6 months between September 2013 and September 2016.Methods Patients with eyes receiving either intravitreal anti-VEGF treatment or PRP with the next follow-up visit occurring more than 6 months after treatment were identified. Visual acuity (VA) and anatomic outcomes at the visit before being LTFU, the return visit, the 6-month visit after return, the 12-month visit after return, and the final visit were gathered and compared between the 2 treatment groups.Main outcomes measures Visual acuity and anatomic outcomes.Results Seventy-six eyes of 59 patients were included in the study, of which 30 received IVI with anti-VEGF and 46 received PRP. In the anti-VEGF group, mean VA worsened significantly when comparing the visit before being LTFU (0.43±0.38 logarithm of the minimum angle of resolution [logMAR]) with the return visit (0.97±0.80 logMAR; P = 0.001) as well as with the final visit (0.92±0.94 logMAR; P = 0.01). In the PRP group, mean VA worsened significantly when comparing the visit before being LTFU (0.42±0.34 logMAR) with the return visit (0.62±0.64 logMAR; P = 0.03). However, no significant difference was observed at the final visit (0.46±0.47 logMAR; P = 0.38). There was a significantly greater number of eyes with tractional retinal detachment in the IVI group compared with the PRP group at the final visit (10 vs. 1, respectively; P = 0.005). There was a significantly greater incidence of neovascularization of the iris in the IVI arm compared with the PRP arm at the final visit (4 vs. 0, respectively; P = 0.02).Conclusions Eyes with PDR that received only intravitreal anti-VEGF demonstrated worse anatomic and functional outcomes after being LTFU compared with eyes that received PRP. Given the potential sequelae of being LTFU, the choice of treatment for PDR must be considered carefully.
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ACE inhibitors, ARBs, and fibrates may have specific benefit in diabetic retinopathy.
“In addition, pharmacologic treatment approaches may have specific benefit in diabetic retinopathy, including ACE inhibitors, ARBs,529,530 and fibrate lipid-lowering agents.531–533”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [533]
The Discussion (pp. 3, 5–6) addresses intravitreal anti-VEGF treatment for proliferative diabetic retinopathy, not the drug classes named in the claim. Searches for ACE inhibitors, ARBs, and fibrates found no passage in our copy assessing their benefit for diabetic retinopathy. (LLM, conf=0.78)
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- Authors
- Obeid, A., Su, D., Patel, S. N., Uhr, J. H., Borkar, D., Gao, X., Fineman, M. S., Regillo, C. D., Maguire, J. I., Garg, S. J., & Hsu, J.
- Affiliations
- Mid Atlantic Retina (US)
- Corresponding author
- Hsu, Jason
- ORCID
- Venue
- Ophthalmology
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 126
- Issue
- 3
- Pages
- 407-413
- ISSN
- 0161-6420 (ISSN-L)
- OpenAlex
- W2886506590
- Cited by
- 180
- References
- 17
- Citations by year
- 2026: 24 · 2025: 22 · 2024: 24 · 2023: 28 · 2022: 22 · 2021: 31 · 2020: 18 · 2019: 9 · 2018: 2
- FWCI
- 15.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal and Macular Surgery
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinopathy of Prematurity Studies
- Keywords
- proliferative diabetic retinopathy, loss to follow-up, panretinal photocoagulation, intravitreal anti-VEGF therapy, visual acuity outcomes, tractional retinal detachment, iris neovascularization
- MeSH terms
- Bevacizumab, Ranibizumab, Adult, Aged, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Retinopathy, Female, Humans, Male, Middle Aged, Recombinant Fusion Proteins, Retrospective Studies, Visual Acuity, Retinal Neovascularization, Treatment Outcome, Laser Coagulation, Angiogenesis Inhibitors, Receptors, Vascular Endothelial Growth Factor, Tomography, Optical Coherence, Vascular Endothelial Growth Factor A, Intravitreal Injections, Lost to Follow-Up
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