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.

Abstract

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. Retrospective clinical cohort study. 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). 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. 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.