Epidemiological Analysis of Patients with Vitreoretinal Diseases Undergoing Intravitreal Therapy at a Referral Hospital in the State of Pará

Abstract

Introduction: The intravitreal injection has become one of the most frequently performed invasive procedures in ophthalmology in the last few years. The intravitreal therapy with antiangiogenics is considered the first line of treatment for several retinal diseases through the inhibition of messenger RNA synthesis, transcription or direct blockade of action of vascular endothelial growth factor (VEGF). The most commonly used antiangiogenic agents today are: ranibizumab, bevacizumab, aflibercept and faricimab. Triamcinolone, a potent steroid, is also used in refractory cases. According to the Brazilian Retina and Vitreous Society, the pathologies most treated with anti-VEGF were Age-Related Macular Degeneration (AMD), followed by Diabetic Macular Edema (DME) and RVO. Objective: To analyze the epidemiological impact of intravitreal therapy on patients with vitreoretinal diseases treated at the Hospital Universitário Bettina Ferro de Souza in Belém, Pará. Methods: An observational, cross-sectional, descriptive study with a quantitative approach was carried out. The medical records of 419 patients with vitreoretinal disease and indication of intravitreal therapy were analyzed between January 2018 and August 2023 in an Ophthalmological Reference Centre, evaluating visual acuity, sex, origin, age, injected eye, number of injections, substance injected and underlying disease, using the Chi-Square test of independence with the help of Excel (Microsoft Office) and Epi Info programs. Results: Among the 419 patients evaluated and 540 eyes injected, the average age observed was 66.6 years, there was no predominance of sex and the majority of patients came from the State of Pará. Diabetic Macular Edema (DME) was the most prevalent disease, followed by AMD and retinal occlusion. 68.3% at least started treatment and received one or more substances. AMD and DR correspond to 81.6% of injections administered and Ranibizumab is the most used drug, corresponding to 93% of injections. Considering visual acuity, an improvement was evident after therapy. Conclusion: This work reinforced the difficulty in accessing ocular health and availability of intravitreal treatment with antiangiogenic drugs faced by these patients, worsening their visual prognosis.  These medications have a high financial cost and a major impact on vitreoretinal diseases, therefore it is necessary to manage these patients, as well as the early diagnosis of different vitreoretinal disorders that can be treated with these medications, allowing the identification of the main etiologies prevalent in the Amazon region and helping to prevent these diseases.