This retrospective case series examined the consequences of interrupted anti-VEGF therapy for diabetic retinopathy (DR).

Study design

Researchers identified 13 eyes (12 patients) with type 2 diabetes from six sites. Patients had proliferative (PDR) or nonproliferative diabetic retinopathy (NPDR), with or without diabetic macular edema (DME), and were treated with only anti-VEGF therapy. All patients were temporarily lost to follow-up for a period of time.

Outcomes

Indications for treatment were PDR with DME (7 eyes), PDR without DME (3 eyes) and moderate-to-severe NPDR with DME (3 eyes).

Patients were lost to follow-up due to intercurrent illness (31%), noncompliance (31%) or financial issues (15%). The median length of treatment interruption was 12 months (range 3–25 months). After the treatment hiatus, 9 eyes developed new vitreous hemorrhage, 5 developed neovascular glaucoma and 4 had tractional retinal detachments. Despite treatment of these complications, 77% of eyes lost 3 or more lines of VA and 46% had a final VA of hand motions or worse.

Limitations

The study is retrospective, uses a small sample size and lacks a control group. The cases were only collected through recollection so there may have been recall bias.

Clinical significance

There are several reasons diabetic patients experience lapses in monitoring and treatment of their eye disease. These findings show that therapy lapses in diabetic patients managed solely with anti-VEGF therapy for retinopathy (especially PDR) can have significant and permanent visual consequences