Potential bias of preoperative intravitreal anti-VEGF injection for complications of proliferative diabetic retinopathy
Intravitreal anti-VEGF injection (IVI) is administered before vitrectomy to assist management of proliferative diabetic retinopathy (PDR)-related complications. In the clinical setting, retinal surgeons determine the use of preoperative IVI based on individual criteria. In this study, we investigate...
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| Veröffentlicht in: | PloS one 2021-10, Vol.16 (10), p.e0258415 |
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| creator | Takayama, Kei Someya, Hideaki Yokoyama, Hiroshi Kimura, Takeshi Takamura, Yoshihiro Morioka, Masakazu Terasaki, Hiroto Ueda, Tetsuo Ogata, Nahoko Kitano, Shigehiko Tashiro, Maki Sakamoto, Taiji Takeuchi, Masaru |
| description | Intravitreal anti-VEGF injection (IVI) is administered before vitrectomy to assist management of proliferative diabetic retinopathy (PDR)-related complications. In the clinical setting, retinal surgeons determine the use of preoperative IVI based on individual criteria. In this study, we investigated factors related to the potential bias of retinal surgeons in using IVI prior to vitrectomy for PDR-related complications, and evaluated the real-world outcomes of surgeon-determined preoperative IVI.
Medical records of 409 eyes of 409 patients who underwent 25-gauge vitrectomy for PDR complications at seven Japanese centers (22 surgeons) were retrospectively reviewed. Ocular factors, demographic and general clinical factors, surgical procedures, and postoperative complications were compared between IVI group (patients who received preoperative IVI; 87 eyes, 21.3%) and non-IVI group (patients who did not receive preoperative IVI; 322 eyes, 78.7%). In addition, baseline HbA1c in IVI group and non-IVI group was compared between eyes with and without postoperative complications.
At baseline, IVI group was younger (P |
| doi_str_mv | 10.1371/journal.pone.0258415 |
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Medical records of 409 eyes of 409 patients who underwent 25-gauge vitrectomy for PDR complications at seven Japanese centers (22 surgeons) were retrospectively reviewed. Ocular factors, demographic and general clinical factors, surgical procedures, and postoperative complications were compared between IVI group (patients who received preoperative IVI; 87 eyes, 21.3%) and non-IVI group (patients who did not receive preoperative IVI; 322 eyes, 78.7%). In addition, baseline HbA1c in IVI group and non-IVI group was compared between eyes with and without postoperative complications.
At baseline, IVI group was younger (P<0.001), had shorter duration of diabetes treatment (P = 0.045), and higher frequencies of neovascular glaucoma [NVG] (P<0.001) and tractional retinal detachment [TRD] (P<0.001) compared to non-IVI group. Although IVI group had higher frequencies of intraoperative retinal break and tamponade procedure, there were no significant differences in postoperative complications and additional treatments between two groups. Baseline HbA1c levels were also not correlated with postoperative complications of VH, NVG, and RD both in IVI group and non-IVI group. Logistic regression analysis identified age (P<0.001, odds ratio [OR] 0.95), presence of NVG (P<0.001, OR 20.2), and presence of TRD (P = 0.0014, OR 2.44) as preoperative factors in favor of IVI.
In this multicenter real-world clinical study, younger age and presence of NVG and TRD were identified as potential biases in using IVI before vitrectomy for PDR complications. Eyes that received preoperative IVI had more intraoperative retinal breaks requiring tamponade than eyes not receiving IVI, but postoperative outcome was not different between the two groups.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0258415</identifier><identifier>PMID: 34624063</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Angiogenesis Inhibitors - administration & dosage ; Angiogenesis Inhibitors - adverse effects ; Angiogenesis Inhibitors - therapeutic use ; Bias ; Biology and Life Sciences ; Care and treatment ; Complications ; Diabetes ; Diabetes mellitus ; Diabetic retinopathy ; Diabetic Retinopathy - drug therapy ; Diabetic Retinopathy - surgery ; Eye ; Eye (anatomy) ; Female ; Glaucoma ; Glucose ; Health aspects ; Hemoglobin ; Hospitals ; Humans ; Injection ; Intravitreal Injections ; Male ; Medical records ; Medical referrals ; Medical schools ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Ophthalmology ; Patients ; People and Places ; Postoperative Complications - etiology ; Preoperative Care ; Regression analysis ; Retina ; Retinal detachment ; Retinopathy ; Retrospective Studies ; Surgeons ; Surgery ; Tamponade ; Vascular endothelial growth factor ; Vascular Endothelial Growth Factor A ; Vitrectomy</subject><ispartof>PloS one, 2021-10, Vol.16 (10), p.e0258415</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Takayama et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Takayama et al 2021 Takayama et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-7569411f25e217a15f569de3071deaf0ebbe5a48a287a8d0bb06f6fecc1e059b3</citedby><cites>FETCH-LOGICAL-c758t-7569411f25e217a15f569de3071deaf0ebbe5a48a287a8d0bb06f6fecc1e059b3</cites><orcidid>0000-0002-1477-9014</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500446/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500446/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2101,2927,23865,27923,27924,53790,53792,79471,79472</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34624063$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Vavvas, Demetrios G.</contributor><creatorcontrib>Takayama, Kei</creatorcontrib><creatorcontrib>Someya, Hideaki</creatorcontrib><creatorcontrib>Yokoyama, Hiroshi</creatorcontrib><creatorcontrib>Kimura, Takeshi</creatorcontrib><creatorcontrib>Takamura, Yoshihiro</creatorcontrib><creatorcontrib>Morioka, Masakazu</creatorcontrib><creatorcontrib>Terasaki, Hiroto</creatorcontrib><creatorcontrib>Ueda, Tetsuo</creatorcontrib><creatorcontrib>Ogata, Nahoko</creatorcontrib><creatorcontrib>Kitano, Shigehiko</creatorcontrib><creatorcontrib>Tashiro, Maki</creatorcontrib><creatorcontrib>Sakamoto, Taiji</creatorcontrib><creatorcontrib>Takeuchi, Masaru</creatorcontrib><title>Potential bias of preoperative intravitreal anti-VEGF injection for complications of proliferative diabetic retinopathy</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Intravitreal anti-VEGF injection (IVI) is administered before vitrectomy to assist management of proliferative diabetic retinopathy (PDR)-related complications. In the clinical setting, retinal surgeons determine the use of preoperative IVI based on individual criteria. In this study, we investigated factors related to the potential bias of retinal surgeons in using IVI prior to vitrectomy for PDR-related complications, and evaluated the real-world outcomes of surgeon-determined preoperative IVI.
Medical records of 409 eyes of 409 patients who underwent 25-gauge vitrectomy for PDR complications at seven Japanese centers (22 surgeons) were retrospectively reviewed. Ocular factors, demographic and general clinical factors, surgical procedures, and postoperative complications were compared between IVI group (patients who received preoperative IVI; 87 eyes, 21.3%) and non-IVI group (patients who did not receive preoperative IVI; 322 eyes, 78.7%). In addition, baseline HbA1c in IVI group and non-IVI group was compared between eyes with and without postoperative complications.
At baseline, IVI group was younger (P<0.001), had shorter duration of diabetes treatment (P = 0.045), and higher frequencies of neovascular glaucoma [NVG] (P<0.001) and tractional retinal detachment [TRD] (P<0.001) compared to non-IVI group. Although IVI group had higher frequencies of intraoperative retinal break and tamponade procedure, there were no significant differences in postoperative complications and additional treatments between two groups. Baseline HbA1c levels were also not correlated with postoperative complications of VH, NVG, and RD both in IVI group and non-IVI group. Logistic regression analysis identified age (P<0.001, odds ratio [OR] 0.95), presence of NVG (P<0.001, OR 20.2), and presence of TRD (P = 0.0014, OR 2.44) as preoperative factors in favor of IVI.
In this multicenter real-world clinical study, younger age and presence of NVG and TRD were identified as potential biases in using IVI before vitrectomy for PDR complications. Eyes that received preoperative IVI had more intraoperative retinal breaks requiring tamponade than eyes not receiving IVI, but postoperative outcome was not different between the two groups.</description><subject>Aged</subject><subject>Angiogenesis Inhibitors - administration & dosage</subject><subject>Angiogenesis Inhibitors - adverse effects</subject><subject>Angiogenesis Inhibitors - therapeutic use</subject><subject>Bias</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Complications</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetic retinopathy</subject><subject>Diabetic Retinopathy - drug therapy</subject><subject>Diabetic Retinopathy - surgery</subject><subject>Eye</subject><subject>Eye (anatomy)</subject><subject>Female</subject><subject>Glaucoma</subject><subject>Glucose</subject><subject>Health aspects</subject><subject>Hemoglobin</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Injection</subject><subject>Intravitreal Injections</subject><subject>Male</subject><subject>Medical records</subject><subject>Medical referrals</subject><subject>Medical schools</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Ophthalmology</subject><subject>Patients</subject><subject>People and Places</subject><subject>Postoperative Complications - etiology</subject><subject>Preoperative Care</subject><subject>Regression analysis</subject><subject>Retina</subject><subject>Retinal detachment</subject><subject>Retinopathy</subject><subject>Retrospective Studies</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Tamponade</subject><subject>Vascular endothelial growth factor</subject><subject>Vascular Endothelial Growth Factor A</subject><subject>Vitrectomy</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11r2zAUhs3YWLtu_2BshsHYLpJJlj-km0EpbRcodOyjt-JYPkoUHMuT5G7991Map8SjF8Mgi1fPeSUdnZMkrymZU1bRT2s7uA7aeW87nJOs4DktniTHVLBsVmaEPT2YHyUvvF8TUjBels-TI5aXWU5Kdpz8_moDdsFAm9YGfGp12ju0PToI5hZT0wUHtyY4jAREcHZzfnkR5TWqYGyXautSZTd9axRshdHCtkbvPRoDNQajUhfHzvYQVncvk2caWo-vxv9J8vPi_MfZl9nV9eXi7PRqpqqCh1lVlCKnVGcFZrQCWugoNMhIRRsETbCusYCcQ8Yr4A2pa1LqUqNSFEkhanaSvN359q31csyZlzFdhGVVlvNILHZEY2Ete2c24O6kBSPvBeuWElw8fYsS61JRTlQlKpErLrhmQmnIAYVAmlXR6_O421BvsFG4zV47MZ2udGYll_ZW8oKQPC-jwYfRwNlfA_ogN8YrbFvo0A67c5ciPiKL6Lt_0MdvN1JLiBcwnbZxX7U1ladlxZkgQmy95o9Q8WtwY1QsMG2iPgn4OAmITMA_YQmD93Lx_dv_s9c3U_b9AbuKRRdW3rbDfWVNwXwHKme9d6gfkkyJ3PbHPhty2x9y7I8Y9ubwgR6C9g3B_gInCA2k</recordid><startdate>20211008</startdate><enddate>20211008</enddate><creator>Takayama, Kei</creator><creator>Someya, Hideaki</creator><creator>Yokoyama, Hiroshi</creator><creator>Kimura, Takeshi</creator><creator>Takamura, Yoshihiro</creator><creator>Morioka, Masakazu</creator><creator>Terasaki, Hiroto</creator><creator>Ueda, Tetsuo</creator><creator>Ogata, Nahoko</creator><creator>Kitano, Shigehiko</creator><creator>Tashiro, Maki</creator><creator>Sakamoto, Taiji</creator><creator>Takeuchi, Masaru</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-1477-9014</orcidid></search><sort><creationdate>20211008</creationdate><title>Potential bias of preoperative intravitreal anti-VEGF injection for complications of proliferative diabetic retinopathy</title><author>Takayama, Kei ; Someya, Hideaki ; Yokoyama, Hiroshi ; Kimura, Takeshi ; Takamura, Yoshihiro ; Morioka, Masakazu ; Terasaki, Hiroto ; Ueda, Tetsuo ; Ogata, Nahoko ; Kitano, Shigehiko ; Tashiro, Maki ; Sakamoto, Taiji ; Takeuchi, Masaru</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c758t-7569411f25e217a15f569de3071deaf0ebbe5a48a287a8d0bb06f6fecc1e059b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Angiogenesis Inhibitors - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Takayama, Kei</au><au>Someya, Hideaki</au><au>Yokoyama, Hiroshi</au><au>Kimura, Takeshi</au><au>Takamura, Yoshihiro</au><au>Morioka, Masakazu</au><au>Terasaki, Hiroto</au><au>Ueda, Tetsuo</au><au>Ogata, Nahoko</au><au>Kitano, Shigehiko</au><au>Tashiro, Maki</au><au>Sakamoto, Taiji</au><au>Takeuchi, Masaru</au><au>Vavvas, Demetrios G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Potential bias of preoperative intravitreal anti-VEGF injection for complications of proliferative diabetic retinopathy</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-10-08</date><risdate>2021</risdate><volume>16</volume><issue>10</issue><spage>e0258415</spage><pages>e0258415-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Intravitreal anti-VEGF injection (IVI) is administered before vitrectomy to assist management of proliferative diabetic retinopathy (PDR)-related complications. In the clinical setting, retinal surgeons determine the use of preoperative IVI based on individual criteria. In this study, we investigated factors related to the potential bias of retinal surgeons in using IVI prior to vitrectomy for PDR-related complications, and evaluated the real-world outcomes of surgeon-determined preoperative IVI.
Medical records of 409 eyes of 409 patients who underwent 25-gauge vitrectomy for PDR complications at seven Japanese centers (22 surgeons) were retrospectively reviewed. Ocular factors, demographic and general clinical factors, surgical procedures, and postoperative complications were compared between IVI group (patients who received preoperative IVI; 87 eyes, 21.3%) and non-IVI group (patients who did not receive preoperative IVI; 322 eyes, 78.7%). In addition, baseline HbA1c in IVI group and non-IVI group was compared between eyes with and without postoperative complications.
At baseline, IVI group was younger (P<0.001), had shorter duration of diabetes treatment (P = 0.045), and higher frequencies of neovascular glaucoma [NVG] (P<0.001) and tractional retinal detachment [TRD] (P<0.001) compared to non-IVI group. Although IVI group had higher frequencies of intraoperative retinal break and tamponade procedure, there were no significant differences in postoperative complications and additional treatments between two groups. Baseline HbA1c levels were also not correlated with postoperative complications of VH, NVG, and RD both in IVI group and non-IVI group. Logistic regression analysis identified age (P<0.001, odds ratio [OR] 0.95), presence of NVG (P<0.001, OR 20.2), and presence of TRD (P = 0.0014, OR 2.44) as preoperative factors in favor of IVI.
In this multicenter real-world clinical study, younger age and presence of NVG and TRD were identified as potential biases in using IVI before vitrectomy for PDR complications. Eyes that received preoperative IVI had more intraoperative retinal breaks requiring tamponade than eyes not receiving IVI, but postoperative outcome was not different between the two groups.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>34624063</pmid><doi>10.1371/journal.pone.0258415</doi><tpages>e0258415</tpages><orcidid>https://orcid.org/0000-0002-1477-9014</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-10, Vol.16 (10), p.e0258415 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2580327248 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Aged Angiogenesis Inhibitors - administration & dosage Angiogenesis Inhibitors - adverse effects Angiogenesis Inhibitors - therapeutic use Bias Biology and Life Sciences Care and treatment Complications Diabetes Diabetes mellitus Diabetic retinopathy Diabetic Retinopathy - drug therapy Diabetic Retinopathy - surgery Eye Eye (anatomy) Female Glaucoma Glucose Health aspects Hemoglobin Hospitals Humans Injection Intravitreal Injections Male Medical records Medical referrals Medical schools Medicine Medicine and Health Sciences Middle Aged Ophthalmology Patients People and Places Postoperative Complications - etiology Preoperative Care Regression analysis Retina Retinal detachment Retinopathy Retrospective Studies Surgeons Surgery Tamponade Vascular endothelial growth factor Vascular Endothelial Growth Factor A Vitrectomy |
| title | Potential bias of preoperative intravitreal anti-VEGF injection for complications of proliferative diabetic retinopathy |
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