Purpose

Loss to follow-up (LTFU) may contribute to vision loss in patients with active proliferative diabetic retinopathy (PDR). The aim of this study is to determine and compare the rates of LTFU in patients with PDR receiving panretinal photocoagulation (PRP) or intravitreal injections (IVIs) with anti-vascular endothelial growth factor (VEGF) over approximately 4 years. Moreover, this study evaluates various risk factors for LTFU.

Design

Retrospective cohort study.

Participants

A total of 2302 patients with PDR receiving IVIs with anti-VEGF or PRP between January 1, 2012, and April 20, 2016.

Methods

Intervals between each procedure and the subsequent follow-up visit were measured. Loss to follow-up was defined as at least 1 interval exceeding 12 months duration.

Main Outcome Measures

The LTFU rates and associated risk factors.

Results

A total of 1718 patients (74.6%) followed up postprocedure and 584 patients (25.4%) were LTFU over approximately 4 years. Of the patients receiving PRP, 28.0% were LTFU compared with 22.1% of patients receiving IVI with anti-VEGF (P = 0.001). The LTFU rates decreased as age increased, with rates of 28.1% for patients aged ≤55 years, 27.0% for patients aged 56 to 65 years, and 20.9% for patients aged >65 years (P = 0.002). Loss to follow-up also differed by race, with rates of 19.4% for whites, 30.2% for African Americans, 19.7% for Asians, 38.0% for Hispanics, Native Americans, and Pacific Islanders, and 34.9% for patients of unreported race (P < 0.001). The LTFU rates also increased as regional average adjusted gross incomes (AGIs) decreased, with rates of 33.9% for patients with regional average AGI of ≤$40 000, 24.0% for patients with regional average AGI from $41 000 to $80 000, and 19.7% for patients with regional average AGI >$80 000 (P < 0.001). Procedure type, age, race, and regional average AGI were all significant (P < 0.05) independent risk factors of LTFU in the multivariate regression.

Conclusions

A large proportion of patients with PDR were LTFU after receiving PRP or an anti-VEGF injection over approximately 4 years. Key risk factors included age, race, and regional average AGI.

中文翻译：

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全视网膜光凝或玻璃体内抗VEGF注射后增生性糖尿病视网膜病变患者的随访损失

目的

活动性糖尿病性视网膜病变（PDR）患者的随访失调（LTFU）可能导致视力下降。这项研究的目的是确定并比较接受抗视网膜血管内皮生长因子（VEGF）的全视网膜光凝（PRP）或玻璃体内注射（IVIs）的PDR患者在大约4年中的LTFU发生率。此外，本研究评估了LTFU的各种危险因素。

设计

回顾性队列研究。

参加者

在2012年1月1日至2016年4月20日期间，共有2302名PDR患者接受了抗VEGF或PRP的IVI。

方法

测量每个程序和随后的随访之间的间隔。随访损失定义为至少1个间隔超过12个月的持续时间。

主要观察指标

LTFU率和相关的危险因素。

结果

大约4年后，共有1718例患者（74.6％）接受了随访，584例患者（25.4％）接受了LTFU。在接受PRP的患者中，LTFU为28.0％，而接受抗VEGF的IVI的患者为22.1％（P  = 0.001）。LTFU率随着年龄的增长而降低，≤55岁的患者为28.1％，56-65岁的患者为27.0％，> 65岁的患者为20.9％（P  = 0.002）。种族的失访率也有所不同，白人的比率为19.4％，非洲裔美国人的比率为30.2％，亚洲人的比率为19.7％，西班牙裔，美洲原住民和太平洋岛民的比率为38.0％，未报告种族的患者比率为34.9％（P <0.001）。LTFU率也随着区域平均调整后总收入（AGI）的下降而增加，区域平均AGI≤40,000美元的患者的比率为33.9％，区域平均AGI从$ 41 000到$ 80 000的患者为24.0％，和19.7％对于区域平均AGI> $ 80 000的患者（P  <0.001）。在多元回归分析中，手术类型，年龄，种族和区域平均AGI都是LTFU的重要独立危险因素（P <0.05）。

结论

大约4年后，接受PRP或抗VEGF注射后，大部分PDR患者为LTFU。关键风险因素包括年龄，种族和区域平均AGI。