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. 2023 Jun 2:17:1565-1573.
doi: 10.2147/OPTH.S414621. eCollection 2023.

Profile of Patients Treated with Intravitreal Anti-Vascular Endothelial Growth Factor Injections in Bhutan

Bhim Bahadur Rai  1   2 , Deepa Rai  3 , Ted Maddess  1
Affiliations

Profile of Patients Treated with Intravitreal Anti-Vascular Endothelial Growth Factor Injections in Bhutan

Bhim Bahadur Rai et al. Clin Ophthalmol. .

Abstract

Purpose: Ocular vascular diseases are common causes of visual impairment and blindness, for which anti-vascular endothelial growth factor (anti-VEGF) is the first-line therapy. Current study describes the profile of patients receiving intravitreal anti-VEGF injections (IVI), and gender variation in Bhutan. The study was designed to inform national health policy.

Study design: Retrospective cross-sectional study.

Methods: We reviewed the surgical registers of the vitreoretinal (VR) units across Bhutan over three years. Patient demography, clinical findings, diagnostic tests performed, and diagnoses or indications for IVI were logged. A descriptive analysis was performed.

Results: Despite limited availability of anti-VEGF, a total of 381 patients received IVI in operating theatres as mandated by the national guidelines. The majority of patients were males (230, 60.4%, p = 0.004). The mean age was 65.2 ± 13.5 years (range 13 years to 90 years), and a median of 69 years. The majority of the treated eyes (117, 30.7%) had BCVA <3/60 to light perception (PL), and another 51 eyes (13.4%) had < 6/60 to 3/60. The most common indication for IVI was neovascular age-related macular degeneration (nAMD) (168 cases, 42.2%), followed by retinal vein occlusion (RVO) (132 cases, 34.6%), diabetic macular oedema (DMO) and retinopathy (DR) (50 cases, 13.1%), and myopic choroidal neovascular membrane (11 cases, 0.03%).

Conclusion: Limited human resources for managing VR diseases in Bhutan are compounded by economic and geographic challenges. With increasing VR diseases such as nAMD and myopia and complications of systemic diseases such as DR, DMO and RVO, there is a need to improve VR services. Currently, anti-VEGF is procured only for a pooled patients requiring IVI, and patients are lost due to longer waiting periods. Bhutan needs to assess if females are reporting less or are not receiving treatment due to cultural barriers and social stigma.

Keywords: Bhutan retinal diseases; anti-VEGF; diabetic macular oedema; intravitreal injection; neovascular AMD; retinal vein occlusion.

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Conflict of interest statement

BBR reports a scholarship provided by the Australian National University that supported the study. TM report grants from the MRFF Biotechnology Bridge (BTB) Program – research grant number: BTBR100196, during the conduct of the study; and grants from Konan Medical USA, outside the submitted work. In addition, he has a patent application (P0040304AU) on novel analysis methods for mfPOP/OFA pending to Konan Medical USA. He owns shares from EyeCo Pty Ltd. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Age distribution of the male and female patients in years. It shows male predominance after 60 years of age.
See this image and copyright information in PMC

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