Anti-VEGF therapy interruption may lead to blindness in diabetic retinopathy

04 Apr 2019
Anti-VEGF therapy interruption may lead to blindness in diabetic retinopathy

Unintentional treatment interruptions in diabetic retinopathy patients, especially those with proliferative disease, managed with antivascular endothelial growth factor (anti-VEGF) therapy alone can result in irreversible blindness, as shown in a recent study.

Researchers retrospectively reviewed the medical records of 12 type 2 diabetes patients (13 eyes; mean age, 56.6 years; 50 percent female) treated exclusively with anti-VEGF therapy for proliferative (PDR) or nonproliferative diabetic retinopathy (NPDR), with or without diabetic macular oedema (DME), and temporarily lost to follow-up.

Anti-VEGF therapy was indicated for PDR with DME in seven (54 percent) eyes, PDR without DME in three (23 percent) eyes and moderate-to-severe NPDR with DME in three (23 percent) eyes. Bevacizumab was used in 10 (77 percent) eyes.

Prior to treatment interruption, patients had been treated for an average of 16.8 months with a mean of 7.1 injections. The mean visual acuity (VA) prior to the treatment hiatus was 0.61 logMAR, and eight eyes (62 percent) had Snellen VA of ≥20/80.

Treatment interruption occurred due to intercurrent illness (31 percent), noncompliance (31 percent) and financial issues (15 percent). The median length of the hiatus was 12 months (range, 3–25 months).

Upon follow-up, most of the treated eyes developed complications: nine (69 percent) had new vitreous haemorrhage, five (38 percent) had neovascular glaucoma and four (31 percent) had traction retinal detachment. Despite treatment of these complications, 10 eyes (77 percent) lost ≥3 lines of VA, with 46 percent of eyes having a final VA of hand motion or worse.

The present data indicate that suspending anti-VEGF therapy for diabetic retinopathy results in marked progression of disease with potentially devastating visual consequences, researchers said. Clinicians should carefully consider this when making initial treatment decisions.

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