American journal of ophthalmology · 2026
Therapeutic Response to Anti-Vascular Endothelial Growth Factor Retreatment Among Eyes With Stabilized Vision After Being Lost to Follow-Up in Diabetic Macular Edema: A Nationwide, Registry-Based Cohort Study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Zhou Chuandi, Shen Yinchen, Li Shu, Li Yong, Li Xiaorong, Yang Xiaolu, Xu Yupeng, Wang Xian, Yang Qing, Sun Dawei, Zhang Wenfang, Li Suyan, Zhang Han, Lv Hongbin, Ma Xiang, Yu Honghua, Song Zongming, Zhang Tianzi, Yu Xuhui, Liu Yong, Niu Tongtong, Yuan Rongdi, You Zhipeng, Liu Qing, Song Yanping, Cao Ningyao, Zhu Dongqing, Sun Xiaodong, Zheng Zhi, Liu Kun, Xu Xun
Аннотация
PURPOSE: To describe the visual and anatomical changes after restarting anti-vascular endothelial growth factor (VEGF) therapy in patients with diabetic macular edema who returned with stabilized vision after being lost to follow-up (LTFU), and to explore the distinct predictors of clinical benefits upon retreatment.
DESIGN: Retrospective clinical cohort study.
METHODS: In this study, 976 patients who returned after being LTFU for ≥6 months were included. All participants had center-involved diabetic macular edema and presented with visual acuity (VA) <20/25 and central foveal thickness (CFT) ≥250 μm. VA and CFT were assessed before being LTFU, at return, and after retreatment. Patients were stratified into two groups: (1) Patients who returned with stabilized VA (the first VA upon returning ≥ the last recorded VA prior to being LTFU), and (2) patients who returned with vision decline (the first VA upon returning < the last recorded VA prior to being LTFU).
RESULTS: After a median LTFU period of 259 days, 447 patients (45.8%) had stabilized VA, and 529 patients (54.2%) had vision decline. With similar follow-up periods (361 vs 356 days) after retreatment, visual gain was obtained in 32.7% of patients with stabilized VA, significantly lower than in those with vision decline (62.0%, P < .001). Consistently, CFT reduction by ≥10% was achieved in 56.4% of patients with stabilized vision and in 63.2% of those with decreased vision (P = .038) over similar follow-up periods (377 vs 361 days). Multivariate logistic regression analysis indicated that the odds of visual (odds ratio = 0.29, 95% CI:0.22-0.38, P < .001) and anatomical (odds ratio = 0.78, 95% CI: 0.59-1.02, P = .073) improvements were lower in patients who returned with stabilized VA, but increased with more anti-VEGF injections administered during retreatment (both P < .001). Notably, patients presenting with stabilized VA of 20/50 or better did not obtain vision gain after retreatment despite anatomical improvement.
CONCLUSIONS: Patients who returned with stabilized vision exhibited suboptimal visual and anatomical responses to anti-VEGF retreatment. Those with VA of 20/50 or better did not improve sufficiently in vision despite anatomical improvements. The decision to readminister anti-VEGF therapy in patients returning with stabilized moderate-to-good vision should be weighed carefully, and alternative or combination therapies may be warranted.
DESIGN: Retrospective clinical cohort study.
METHODS: In this study, 976 patients who returned after being LTFU for ≥6 months were included. All participants had center-involved diabetic macular edema and presented with visual acuity (VA) <20/25 and central foveal thickness (CFT) ≥250 μm. VA and CFT were assessed before being LTFU, at return, and after retreatment. Patients were stratified into two groups: (1) Patients who returned with stabilized VA (the first VA upon returning ≥ the last recorded VA prior to being LTFU), and (2) patients who returned with vision decline (the first VA upon returning < the last recorded VA prior to being LTFU).
RESULTS: After a median LTFU period of 259 days, 447 patients (45.8%) had stabilized VA, and 529 patients (54.2%) had vision decline. With similar follow-up periods (361 vs 356 days) after retreatment, visual gain was obtained in 32.7% of patients with stabilized VA, significantly lower than in those with vision decline (62.0%, P < .001). Consistently, CFT reduction by ≥10% was achieved in 56.4% of patients with stabilized vision and in 63.2% of those with decreased vision (P = .038) over similar follow-up periods (377 vs 361 days). Multivariate logistic regression analysis indicated that the odds of visual (odds ratio = 0.29, 95% CI:0.22-0.38, P < .001) and anatomical (odds ratio = 0.78, 95% CI: 0.59-1.02, P = .073) improvements were lower in patients who returned with stabilized VA, but increased with more anti-VEGF injections administered during retreatment (both P < .001). Notably, patients presenting with stabilized VA of 20/50 or better did not obtain vision gain after retreatment despite anatomical improvement.
CONCLUSIONS: Patients who returned with stabilized vision exhibited suboptimal visual and anatomical responses to anti-VEGF retreatment. Those with VA of 20/50 or better did not improve sufficiently in vision despite anatomical improvements. The decision to readminister anti-VEGF therapy in patients returning with stabilized moderate-to-good vision should be weighed carefully, and alternative or combination therapies may be warranted.
Предметные рубрики MeSH
HumansDiabetic RetinopathyFemaleVisual AcuityMacular EdemaRetrospective StudiesAngiogenesis InhibitorsVascular Endothelial Growth Factor AIntravitreal InjectionsMaleRetreatmentTomography, Optical CoherenceRanibizumabMiddle AgedAgedBevacizumabFollow-Up StudiesRegistriesLost to Follow-UpTreatment OutcomeFluorescein Angiography