Audit of anti-vascular endothelial growth factor medication use in Ekiti, Southwestern Nigeria

Department of Ophthalmology, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria.AbstractBackground: The use of anti-vascular endothelial growth factor (anti-VEGF) agents has increased in recent years. This is because of the increasing detection of vitreo-retinal disorders associated with vascular abnormalities. The indications vary from one location to another. Visual outcome following treatment with these agents also vary with disease severity and promptness of intervention.Methodology: A prospective observational study was carried out on all patients with retinal disorders who had intravitreal injection between November 2013 and November 2019. Data on demographic characteristics, presenting visual acuity, diagnosis, type of anti-VEGF agent used, post-treatment visual acuity and complications were retrieved and entered into Statistical Package for Social Sciences (SPSS) version 25 and analysed for frequency and proportions.Results: Seven hundred and thirty two patients with retinal pathologies were seen during the study period. A total of 251 intravitreal anti-VEGF agent injections were administered to 95 patients during the period under review. The mean age of the patients was 64.3 ±12.7 years. The number of injections per eye varied from 2 to 6 with an average of 2.6 per eye. Bevacizumab was the more commonly utilized anti-VEGF medication as it was used for 231(92%) injections. Wet age-related maculopathy was the commonest indication for intravitreal anti-VEGF agent in 61(24.3%) followed by diabetic macula edema in 55(21.9%) and retinal vein occlusion with macular edema in 54(21.5%) injections. Visual improvement was observed in 69 (72.6%) patients.Conclusion: Anti-VEGF therapy was useful in the management of patients with retinal disorders. The need for multiple injections and the attendant cost still constitutes a major challenge in the use of these medications. Keywords: Intravitreal, Retina, Bevacizumab, Ranibizumab, Retina disorders, Antivascular endothelial growth factor agents.Resume Contexte: L’utilisation d’agents anti-facteur de croissance endothelial vasculaire (anti-VEGF) a augmente ces dernieres annees. Ceci est du a la detection croissante des troubles vitreo-retiniens associes auxanomalies. Les indications varient d’un endroit a l’autre. Le resultat visuel apres le traitement avec ces agents varie egalement en fonction de la gravite de la maladie et de la rapidite de l’intervention.Methodologie: Une etude observationnelle prospective a ete menee sur tous les patients atteints de retinetroubles ayant subi une injection intravitreenne entre novembre 2013 et novembre 2019. Donnees sur les caracteristiques demographiques, presentant l’acuite visuelle, le diagnostic, le type de agent anti-VEGF utilise, l’acuite visuelle post-traitement et les complications ont ete recuperees et entre dans le progiciel statistique pour les sciences sociales (SPSS) version 25 et analyse pour frequence et proportions.Resultats: Sept cent trente-deux patients atteints de pathologies retiniennes ont ete vus au cours de la periode d’etude. Au total, 251 injections d’agent anti-VEGF intravitreen ont ete administrees a 95 patients au cours de la periode sous revue. L’âge moyen des patients etait de 64,3 ± 12,7 ans. Le nombre d’injections par œil variait de 2 a 6 avec une moyenne de 2,6 par œil. Le bevacizumab etait le medicament anti-VEGF le plus couramment utilise car il etait utilise pour 231 injections (92%). La maculopathie humide liee a l’âge etait l’indication la plus courante de l’anti-VEGF intravitreen chez 61 (24,3%), suivie de l’œdeme diabetique de la macula dans 55 (21,9%) et de l’occlusion veineuse retinienne avec œdeme maculaire dans 54 (21,5%) injections. Une amelioration visuelle a ete observee chez 69 patients (72,6%).Conclusion: La therapie anti-VEGF a ete utile dans la prise en charge des patients atteints de troubles retiniens. La necessite de multiples injections et le cout associe constituent toujours un defi majeur dans l’utilisation de ces medicaments.Mots cles: Intravitreen, Retine, Bevacizumab, Ranibizumab, Troubles de la retine, Agents de facteur de croissance endothelial anti-vasculaire.Correspondence: Dr. I.A. Ajayi, Department of Ophthalmology, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. E-mail:iyiseye2005@gmail.com