Intravitreal anti-VEGF therapy is not associated with a higher risk of all-cause mortality in patients with macular oedema caused by posterior segment vascular diseases.

PURPOSE: To examine whether real-world clinical patients with macular oedema (MO) receiving intravitreal antivascular endothelial growth factor (VEGF) therapy have a higher mortality compared with a matched reference population. METHODS: A population-based, retrospective cohort study of 26 386 patients from Finland, from January 1, 2001, to December 31, 2017. Index patients were identified through the Caring Epidemiology Project database, receiving at least one intravitreal anti-VEGF injection for wet age-related macular degeneration (AMD, n = 2243, 48.61%), diabetic MO (n = 744, 16.12%), MO due to retinal vascular occlusion (n = 589, 12.77%), or other MO (n = 1038, 22.5%). For each individual treated with intravitreal injection (n = 4614), five age- , sex- , calendar year- and hospital district- matched control individuals (n = 21 772) were chosen. Baseline data of chronic conditions were available. All-cause and cause-specific mortality was analysed using Cox´s proportional hazards model. RESULTS: In general, the anti-VEGF treated patients had a higher prevalence of systemic conditions, including diabetes (60.1% vs. 46.8%, p < 0.001), chronic hypertension (38.4% vs. 34.6%, p < 0.001), in hospital-treated ischaemic heart disease (23.1% vs. 21.5%, p = 0.014), and glaucoma (11.1% vs. 6.3%, p < 0.001) than controls. There was no difference in all-cause mortality between the anti-VEGF treated patients and matched controls (p = 0.62). In unadjusted Kaplan-Meier analysis of wet AMD subgroup, all-cause mortality was lower in anti-VEGF treated patients than matched controls (p = 0.015), but adjusted Cox´s proportional hazards model showed no difference in the risk of all-cause mortality (HR 0.85, 95% CI 0.66-1.09). CONCLUSIONS: Intravitreal anti-VEGF therapy was not associated with an increase in the risk of mortality in patients with MO compared with age- and sex-matched controls.

Clinically significant macular edema and survival in type 1 and type 2 diabetes.

PURPOSE: To investigate the association of clinically significant macular edema (CSME) and long-term survival in individuals with type 1 and type 2 diabetes. DESIGN: Population-based cohort study. METHODS: The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) is an ongoing prospective population-based cohort study initiated from August 21, 1980 through July 30, 1982 of individuals with diabetes diagnosed at either younger than 30 years of age (younger-onset group; n = 996) or 30 years of age or older (older-onset group; n = 1,370). Stereoscopic color retinal photographs were graded for retinopathy using the modified Airlie House classification scheme. CSME was defined by the Early Treatment Diabetic Retinopathy Study criteria. RESULTS: Prevalence of CSME was 5.9% and 7.5% for the younger- and older-onset groups, respectively. After 20 years of follow-up, 276 younger-onset and 1,197 older-onset persons died. When adjusting for age and gender, CSME was not significantly associated with all-cause mortality (hazard ratio [HR], 1.41; 95% confidence interval [CI], 0.96 to 2.07; P = .08) or ischemic heart disease mortality (HR, 1.14; 95% CI, 0.61 to 2.12; P = .68) in the younger-onset group. In the older-onset group, there was increased all-cause and ischemic heart disease mortality when CSME was present (HR, 1.55; 95% CI, 1.25 to 1.92; P < .01; and HR, 1.56; 95% CI, 1.15 to 2.13; P < .01, respectively), when adjusting for age and gender. After controlling for other risk factors, the association remained significant for ischemic heart disease (HR, 1.58; 95% CI, 1.07 to 2.35; P = .02) among those taking insulin. CSME was not significantly associated with stroke mortality in either group. CONCLUSIONS: CSME seems to be a risk indicator for decreased survival in persons with older-onset diabetes mellitus. The presence of CSME may identify individuals who should be receiving care for detection and treatment of cardiovascular disease.

The cost-effectiveness of grid laser photocoagulation for the treatment of diabetic macular edema: results of a patient-based cost-utility analysis.

Grid laser therapy has been demonstrated to be of benefit for the treatment of diabetic macular edema. The purpose of the present study was to determine the cost-effectiveness of grid laser therapy for the treatment of diabetic macular edema. The analysis was performed from the perspective of a third-party insurer. Decision analyses and cost-effectiveness analyses were performed by incorporating the data from the Early Treatment Diabetic Retinopathy Study, expected longevity data, and patient-based utilities. Various sensitivity analyses were performed to determine the robustness of the models. Laser treatment conferred an overall improvement in quality-of-life adjusted years of approximately 3 months over the duration of disease for a hypothetical patient. The unadjusted cost per quality-of-life adjusted year (QALY) was US$3,101. Net present value analysis demonstrated that the cost per QALY could increase to $3,655, assuming a 5% discount rate. Overall, grid laser photocoagulation for diabetic macular edema is a very cost-effective treatment based on the results of this cost-utility analysis.