Ophthalmology science · 2026
Persistent Vision Loss of Eyes Lost to Follow-Up with Diabetic Macular Edema Receiving Intravitreal Anti-VEGF Therapy.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Zhou Chuandi, Shen Yinchen, Li Shu, Li Yong, Zhu Dongqing, Li Xiaorong, Yang Xiaolu, Xu Yupeng, Wang Xian, Cao Ningyao, 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, Sun Xiaodong, Zheng Zhi, Liu Kun, Xu Xun
Аннотация
PURPOSE: To describe the visual and anatomic outcomes after being lost to follow-up (LTFU) among patients with diabetic macular edema (DME) that treated by intravitreal anti-VEGF therapies, and to determine the risk factors of persistent vision loss.
DESIGN: A retrospective cohort study using national registry data.
PARTICIPANTS: A total of 5660 patients who were LTFU >6 months after anti-VEGF treatments from April 2020 through July 2024.
METHODS: Visual and anatomic outcomes at the visit before being LTFU, the return visit, 3 months, 6 months, and 12 months after return, and the final visit were collected. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of risk factors for persistent vision loss.
MAIN OUTCOME MEASURES: Visual acuity (VA) and central foveal thickness (CFT).
RESULTS: After a mean LTFU period of 11.3 months, 2712 (47.9%) patients had vision decline at return visit. Identified risk factors included increasing age (45-64 years vs. ≤44 years: OR, 1.30; 95% CI, 1.07-1.56; P = 0.007; ≥65 years vs. ≤44 years: OR, 1.41; 95% CI, 1.15-1.72; P = 0.001), being treated in less developed regions (OR, 1.20; 95% CI, 1.08-1.34; P = 0.001), better baseline VA (20/50-20/200 vs. worse than 20/200: OR, 3.20; 95% CI, 2.67-3.83; P < 0.001; 20/40 or better vs. worse than 20/200: OR, 5.89; 95% CI, 4.86-7.12; P < 0.001), and being LTFU for >12 months (OR, 1.22; 95% CI, 1.09-1.37; P = 0.001). A total of 792 patients returned with worsened vision and underwent ≥12 months of follow-up after resuming therapies. After a mean follow-up time of 17.3 months, 522 (65.9%) patients had persistent vision loss. Central foveal thickness presented paralleled changes with VA. Odds of persistent vision loss were greater among patients with VA of 20/40 or better before being LTFU (OR, 2.54; 95% CI, 1.25-5.15; P = 0.010) or having CFT of 350μm or more at return (OR, 1.57; 95% CI, 1.15-2.16; P = 0.005). In retreatment, odds of persistent vision loss were lower for patients who switched anti-VEGF agents (OR, 0.61; 95% CI, 0.45-0.84; P = 0.002) after return.
CONCLUSIONS: Nearly half of the patients had vision decline after being LTFU, and after resuming therapies, vision loss still persisted in 2 of 3 patients. Clinical adherence should be strengthened for patients with baseline VA of 20/40 or better or having CFT of 350 μm or more at return. Multiple agents used were associated with vision recovery.
FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: A retrospective cohort study using national registry data.
PARTICIPANTS: A total of 5660 patients who were LTFU >6 months after anti-VEGF treatments from April 2020 through July 2024.
METHODS: Visual and anatomic outcomes at the visit before being LTFU, the return visit, 3 months, 6 months, and 12 months after return, and the final visit were collected. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of risk factors for persistent vision loss.
MAIN OUTCOME MEASURES: Visual acuity (VA) and central foveal thickness (CFT).
RESULTS: After a mean LTFU period of 11.3 months, 2712 (47.9%) patients had vision decline at return visit. Identified risk factors included increasing age (45-64 years vs. ≤44 years: OR, 1.30; 95% CI, 1.07-1.56; P = 0.007; ≥65 years vs. ≤44 years: OR, 1.41; 95% CI, 1.15-1.72; P = 0.001), being treated in less developed regions (OR, 1.20; 95% CI, 1.08-1.34; P = 0.001), better baseline VA (20/50-20/200 vs. worse than 20/200: OR, 3.20; 95% CI, 2.67-3.83; P < 0.001; 20/40 or better vs. worse than 20/200: OR, 5.89; 95% CI, 4.86-7.12; P < 0.001), and being LTFU for >12 months (OR, 1.22; 95% CI, 1.09-1.37; P = 0.001). A total of 792 patients returned with worsened vision and underwent ≥12 months of follow-up after resuming therapies. After a mean follow-up time of 17.3 months, 522 (65.9%) patients had persistent vision loss. Central foveal thickness presented paralleled changes with VA. Odds of persistent vision loss were greater among patients with VA of 20/40 or better before being LTFU (OR, 2.54; 95% CI, 1.25-5.15; P = 0.010) or having CFT of 350μm or more at return (OR, 1.57; 95% CI, 1.15-2.16; P = 0.005). In retreatment, odds of persistent vision loss were lower for patients who switched anti-VEGF agents (OR, 0.61; 95% CI, 0.45-0.84; P = 0.002) after return.
CONCLUSIONS: Nearly half of the patients had vision decline after being LTFU, and after resuming therapies, vision loss still persisted in 2 of 3 patients. Clinical adherence should be strengthened for patients with baseline VA of 20/40 or better or having CFT of 350 μm or more at return. Multiple agents used were associated with vision recovery.
FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.