Ranibizumab for exudative age-related macular degeneration: A five year study of adherence to follow-up in a real-life setting.
OBJECTIVE
To analyze adherence to follow-up over 5 years in patients treated with intravitreal ranibizumab for exudative age-related macular degeneration (AMD) in a tertiary health care center. To investigate factors associated with failure to continue follow-up.


METHODS
Retrospective chart review of all consecutive patients with exudative AMD, who received their first intravitreal ranibizumab injection at the Créteil Intercommunal University Hospital Eye Clinic between October 1, 2006 and March 31, 2007. Patient clinical characteristics at baseline and at the last follow-up visit were recorded. Distance from home to hospital was measured for each patient. A multiple-choice telephone survey was conducted for patients lost to follow-up to determine the main reasons for failure to continue follow-up.


RESULTS
Two hundred and one patients were included. The rate of loss to follow-up over the 5-year period was 57% (115/201). Fifty-eight patients lost to follow-up completed the questionnaire. The main reasons reported by patients for follow-up discontinuation were long distance from home to hospital (51.7%, 30/58), subjective dissatisfaction with the benefits of intravitreal injections (34.5%, 20/58), and the excessive burden of periodic follow-up visits (24.1%, 14/58). Three factors were significantly associated with follow-up discontinuation: high age at baseline (82.2 vs. 76.5 years, P<0.001), poor best-corrected visual acuity (BCVA) at baseline (42.5 vs. 51.0 letters, P=0.020), and long distance from home to hospital (132 vs. 17.1km, P<0.001).


CONCLUSIONS
In this study, adherence to follow-up over 5 years was poor. Age and BCVA at baseline and distance from home to hospital were independently associated with long-term adherence.
Department of Ophthalmology, Paris Est Créteil University, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
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Boulanger-Scemama
Department of Ophthalmology, Paris Est Créteil University, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
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Querques
Department of Public Health, Paris Est Créteil University, Henri-Mondor Hospital, 51, avenue du Maréchal de Lattre-de-Tassigny, 94010 Créteil, France; Paris Est Créteil University, LIC, EA4393, 51, avenue du Maréchal de Lattre-de-Tassigny, 94010 Créteil, France.
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About
Department of Ophthalmology, Paris Est Créteil University, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
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Puche
Department of Ophthalmology, Paris Est Créteil University, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
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Srour
Department of Ophthalmology, Paris Est Créteil University, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
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Mane
Department of Ophthalmology, Paris Est Créteil University, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
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Massamba
Department of Public Health, Paris Est Créteil University, Henri-Mondor Hospital, 51, avenue du Maréchal de Lattre-de-Tassigny, 94010 Créteil, France; Paris Est Créteil University, LIC, EA4393, 51, avenue du Maréchal de Lattre-de-Tassigny, 94010 Créteil, France.
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Canoui-Poitrine
Department of Ophthalmology, Paris Est Créteil University, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France. Electronic address: eric.souied@chicreteil.fr.
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Souied
D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006297:Health Services Accessibility; D006801:Humans; D058449:Intravitreal Injections; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D000069579:Ranibizumab / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D012934:Social Isolation; D011795:Surveys and Questionnaires; D014195:Travel; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000191:economics / Q000523:psychology
D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab
Anti-VEGF; Anti-vascular endothelial growth factor; Dégénérescence maculaire liée à l’âge exsudative; Exudative age-related macular degeneration; Long-term follow-up; Ranibizumab; Suivi à long terme