Clinical Characteristics and Compliance of Diabetic Macular Edema Patients to Intravitreal Anti-VEGF Injection Loading Dose at Cipto Mangunkusumo Hospital Oral Presentation - Observational Study - Resident
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Anti-VEGF, Compliance, Diabetic Macular Edema, Loading Dose
Abstract
Introduction & Objectives
Diabetic retinopathy is the fifth most common cause of preventable blindness. In cases of diabetic
macular edema (DME), loading dose is a critical phase to achieve a stable concentration of
intravitreal vascular endothelial growth factor (VEGF) in order to prevent progressivity. This study
aims to determine the demographic and clinical characteristics, waiting time, compliance, as well as
the relationship between education, domicile and clinical outcomes to compliance during loading
dose in DME patients.
Methods
In this retrospective descriptive study, we reviewed medical records of DME patients who received
anti-VEGF intravitreal injection between 1 January 2019 and 31 December 2020, while also
comparing records in 2019 (pre-Covid-19) and 2020 (during Covid-19).
Results
There were 160 patients (207 eyeballs) in 2019 and 83 patients (114 eyeballs) in 2020 who received
loading dose with similar profiles of sex, age, education, initial visual acuity and central macular
thickness (CMT). Median waiting times in 2019 and 2020 were 19 days and 23.5 days, respectively
(p=0.016). Only 25 (30.5%) and 15 (35.7%) patients were punctual in 2019 and 2020, respectively.
There was no significant relationship between education and domicile with compliance (p= 0.45, p=
0.51). Furthermore, there were visual acuity improvements of -0.18 logMAR and -0.0 logMAR in the
punctual and unpunctual group, respectively, as well as CMT decrease of -181 ?m and -156 ?m,
respectively.
Conclusion
Most patients who received loading dose were unpunctual. There was no significant relationship
between education and domicile with compliance. Furthermore, there were more significant
improvements in clinical outcomes among the punctual patients.
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References
World Health Organization. Global report on diabetes. World Health Organization. 2016;
International Diabetes Federation. IDF Diabetes Atlas. 8th ed. Brussels; 2017.
Bourne RRA, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, et al. Causes of vision loss worldwide, 1990–2010: a systematic analysis. Lancet Glob Health. 2013;1.
Ferris FL, Patz A. Macular edema. A complication of diabetic retinopathy. Surv Ophthalmol. 1984;28.
Kleinman ME, Baffi JZ, Ambati J. The Multifactorial Nature of Retinal Vascular Disease. Ophthalmologica. 2010;224.
Kiss S, Liu Y, Brown J, Holekamp N, Almony A, Campbell J, et al. Clinical utilization of anti-vascular endothelial growth-factor agents and patient monitoring in retinal vein occlusion and diabetic macular edema. Clinical Ophthalmology. 2014;
Wykoff CC, Clark WL, Nielsen JS, Brill J v., Greene LS, Heggen CL. Optimizing Anti-VEGF Treatment Outcomes for Patients with Neovascular Age-Related Macular Degeneration. J Manag Care Spec Pharm. 2018;24.
Weiss M, Sim DA, Herold T, Schumann RG, Liegl R, Kern C, et al. Compliance and Adherence of Patients with Diabetic Macular Edema to Intravitreal AntiVascular Endothelial Growth Factor Therapy in Daily Practice. Retina. 2018;38.
Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91.
Mehrotra A, Chernew M, Linetsky D, Hatch H, Cutler D. What Impact Has COVID-19 Had on Outpatient Visits? Commonwealth Fund. 2020;
Yang KB, Feng H, Zhang H. Effects of the COVID-19 Pandemic on Anti-vascular Endothelial Growth Factor Treatment in China. Front Med (Lausanne). 2020;7.
Ashrafzadeh S, Gundlach BS, Tsui I. The Impact of Non-Ophthalmic Factors on Intravitreal Injections During the COVID-19 Lockdown. Clinical Ophthalmology. 2021;Volume 15.
Wong TY, Bandello F. Academic Ophthalmology during and after the COVID-19 Pandemic. Ophthalmology. 2020;127.
Varma R, Bressler NM, Doan Q v., Gleeson M, Danese M, Bower JK, et al. Prevalence of and Risk Factors for Diabetic Macular Edema in the United States. JAMA Ophthalmol. 2014;132.
Ahmad L, Khan T, Bundela R, Singh L, Yadav S. Prevalence of Diabetic Macular Edema in association with Severity of Diabetic Retinopathy. Journal of Medical Science And clinical Research. 2017;05.
Özkiri? A. Intravitreal bevacizumab (Avastin) for primary treatment of diabetic macular oedema. Eye. 2009;23.
World Health Organization. Adherence to long-term therapies: evidence for action. World Health Organization. 2003;
Framme C, Eter N, Hamacher T, Hasanbasic Z, Jochmann C, Johnson KT, et al. Aflibercept for Patients with Neovascular Age-Related Macular Degeneration in Routine Clinical Practice in Germany. Ophthalmol Retina. 2018;2.
Westborg I, Rosso A. Risk Factors for Discontinuation of Treatment for Neovascular Age-Related Macular Degeneration. Ophthalmic Epidemiol. 2018;25.
Ehlken C, Helms M, Böhringer D, Agostini HT, Stahl A. Association of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients. Clinical Ophthalmology. 2017;Volume 12.
Mueller S, Agostini H, Ehlken C, Bauer-Steinhusen U, Hasanbasic Z, Wilke T. Patient Preferences in the Treatment of Neovascular Age-Related Macular Degeneration. Ophthalmology. 2016;123.
McGrath LA, Lee LR. Characteristics of Patients Who Drop Out From Ranibizumab Therapy. Asia-Pacific Journal of Ophthalmology. 2013;2.
Boyle J, Vukicevic M, Koklanis K, Itsiopoulos C, Rees G. Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration. Psychol Health Med. 2018;23.
Best AL, Fajnkuchen F, Nghiem-Buffet S, Grenet T, Quentel G, Delahaye-Mazza C, et al. Treatment Efficacy and Compliance in Patients with Diabetic Macular Edema Treated with Ranibizumab in a RealLife Setting. J Ophthalmol. 2018;2018.
Diabetic Retinopathy Clinical Research Network. Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema. New England Journal of Medicine. 2015;372.
Authors
Copyright (c) 2023 Theresia Kania, Anggun R Yudhanta
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