Association Between Anti-vascular Endothelial Growth Factor Therapy Exposure and Visual Outcomes in Diabetic Macular...

Anti-vascular endothelial growth factor (anti-VEGF) therapy is first-line treatment for diabetic macular edema (DME) and retinal vein occlusion (RVO), but real-world practice often differs from clinical trial findings. This single-center retrospective cohort study used hospital electronic medical records to evaluate anti-VEGF treatment patterns and associations with visual outcomes. We included 332 adults who received at least one intravitreal injection of ranibizumab, aflibercept, or conbercept between January 2022 and January 2024 and had at least one post-baseline best-corrected visual acuity (BCVA) measurement. The cohort included 180 patients with DME, 138 with RVO, and 14 with other retinal vascular diagnoses. Standard treatment required three monthly loading doses, a treat-and-extend regimen with intervals of 4-16 weeks, no interval >16 weeks, and treatment duration ≥12 months; all other patterns were classified as non-standard. The primary outcome was change in LogMAR BCVA at the last available follow-up. The standard and non-standard groups included 132 and 200 patients, respectively. Treatment interruption for ≥6 months was common in the non-standard group (68.50%). Unadjusted visual outcomes favored the standard group (median ΔBCVA, -0.23 vs. -0.07 LogMAR; improvement rate, 68.18% vs. 35.00%; P<0.001). In adjusted analyses, baseline BCVA, total number of injections, and treatment duration were positive predictors of improvement, whereas longer time to first injection was a negative predictor; standard/non-standard grouping was not significant (P=0.853). Safety events were infrequent, limiting comparison of rare events. Non-standard treatment patterns were common and associated with poorer unadjusted visual outcomes; optimizing injection exposure and treatment timing may improve real-world outcomes.