ObjectiveTo compare and analyze the changes in the diagnosis and treatment of intravitreal injection before and after the implementation of centralized management in the "one-stop intravitreal injection center", and to preliminarily explore the advantages of centralized management. MethodsA retrospective cohort study. A total of 5 954 patients (6 481 eyes) who received intravitreal anti-vascular endothelial growth factor (VEGF) injection in Department of Ophthalmology of Macula Clinic (One-stop Intravitreal Injection Center) of Dalian Third People's Hospital from January 1, 2021 to December 31, 2024 were enrolled. Data were obtained from the Hospital Information System, fundus disease database, and intravitreal injection management software of Dalian Third People's Hospital. Among the patients, there were 2 950 males (3 453 eyes) and 3 004 females (3 528 eyes); 3 163 patients lived in urban areas, and 2 791 in suburban or external areas. Regarding the affected eyes, 1 901 eyes had wet age-related macular degeneration (wAMD), 2 340 eyes had diabetic macular edema (DME), 1 874 eyes had macular edema secondary to retinal vein occlusion (RVO-ME), 580 eyes had diabetic retinopathy (DR), and 390 eyes had other fundus diseases. A total of 19 539 anti-VEGF injections were performed in 6 481 eyes. The control group comprised 2 294 patients (2 630 eyes) from January 1, 2021 to April 30, 2022 (before centralized management), and the observation group comprised 3 660 patients (4 351 eyes) from May 1, 2022 to December 31, 2024 (after centralized management). The total number of intravitreal injections, the distribution of anti-VEGF therapy in patients with wAMD, RVO-ME, DME and other fundus diseases, the completion rates of 3, 5 injections in the first year, and patients' medical experience via telephone interviews were compared between the two groups. The Chi-square test or t-test was used for inter-group comparison. ResultsThe cumulative number of injections in the observation group and the control group was 12 552 and 5 747 times, with the average number of injections per eye being (3.43±2.76) and (2.51±1.73) times. The number of eyes that completed 3 injections in the first year was 2,000 (54.64%, 2 000/3 660) and 968 (42.20%, 968/2 294), while the number of eyes that completed 5 injections in the first year was 762 (20.82%, 762/3 660) and 232 (10.11%, 232/2 294). The average number of injections per eye in the observation group (t=23.56) and the completion rates of 3 and 5 injections in the first year (χ2=87.40, 116.22) were significantly higher than those in the control group, and the differences were statistically significant (P＜0.001). The injection frequency and completion rates of 3 and 5 injections in the first year for patients with DME, RVO-ME, and wAMD in the observation group were significantly higher than those in the control group, and the differences were statistically significant (P＜0.05). Stratified by age, the 5-year completion rates in the observation group were significantly higher than those in the control group in patients aged 41-50, 51-60, 61-70, and ＞80 years old (P＜0.05). The 3-year completion rate of injections in the first year in the observation group was significantly higher than that in the control group, but the difference in the 5-year completion rate (α=0.01) was not statistically significant after adjusting the test level (P=0.004). The total number of injections for patients in the observation group living in urban areas and other regions was significantly higher than that in the control group (P＜0.05). The total discharge time and appointment waiting time for patients in the observation group and the control group were (2.08±0.74) and (2.28±0.63) hours respectively, and the process convenience score was (4.35±0.73) and (3.87±0.98) points respectively, and the medical service satisfaction score was (4.35±0.74) and (4.30±0.84) points respectively. Compared with the control group, the total discharge time and appointment waiting time in the observation group were significantly shortened, the process convenience score was significantly improved, and the differences were statistically significant (t=2.55, 3.80, ?5.09; P＜0.05); there was no statistically significant difference in the medical service satisfaction score between the two groups (t=?0.62, P=0.535). ConclusionCentralized management can significantly enhance the operational efficiency and management level of the "one-stop intravitreal injection center", and improve the patient visit rate and treatment compliance.
ObjectiveTo preliminarily investigate the predictive value of volumetric fluctuation index (VFI) of different exudative lesions during anti-vascular endothelial growth factor (VEGF) loading treatment for retreatment requirements within 12 and 24 months in neovascular age-related macular degeneration (nAMD). MethodsA prospective cohort study. From January 1, 2022 to March 31, 2023, 46 patients with nAMD who visited State Key Laboratory of Ophthalmology of Sun Yat-sen University for the first time were included in the study. Among them, 35 were male and 11 were female; the average age was (65.61±7.22) years. All patients received a three-times loading treatment followed by on-demand treatment, and were regularly followed up for 2 years. Using optical coherence tomography (OCT), OCT angiography, and 3D Slicer software, three-dimensional reconstructions were performed for seven types of exudative lesions, including subretinal fluid (SRF), intraretinal fluid (IRF), strong reflective substances under the retina [SHRM, including vascular SHRM (vSHRM) and non-vascular SHRM (avSHRM)], and pigment epithelial detachment [PED, including serous (sPED), fibrovascular PED and hemorrhagic PED (hPED)]. Based on the volume data at baseline and 1, 4, 8, and 12 weeks after treatment, the short-term VFI of each lesion was calculated to evaluate its early fluctuation characteristics. According to whether re-treatment was needed within 12 and 24 months after the end of the loading period, the patients were divided into the supplementary treatment group and the stable group. The Mann-Whitney U test was used to compare the differences in VFI between the two groups; a multivariate linear regression model was used to analyze the independent influencing factors of the number of supplementary treatments. ResultsAmong 46 eyes at 12 months post-loading, 17 and 29 eyes were assigned to the retreatment and stable groups, respectively. SRF-VFI and total fluid-VFI were both significantly higher in the retreatment group than in the stable group (Z=3.221, 2.924; P=0.001, 0.003). At 24 months post-loading, 22 and 24 eyes were in the retreatment and stable groups, respectively; total fluid-VFI remained significantly higher in the retreatment group (Z=2.177, P=0.029). Linear regression analyses revealed that, after adjusting for sex, age, macular neovascularization subtype, anti-VEGF drug subtype, and baseline total lesion volume, total fluid-VFI (standardized β=0.382, 0.460) and IRF-VFI (standardized β=0.359, 0.495) were significantly associated with retreatment frequency within 12 and 24 months post-loading (P＜0.05); SRF-VFI and sPED-VFI (standardized β=0.361, 0.392) were significantly associated with retreatment frequency at 12 and 24 months post-loading, respectively (P＜0.05). Total SHRM-VFI and avSHRM-VFI (standardized β=?0.543, ?0.710) were significantly negatively correlated with retreatment frequency within both 12 and 24 months post-loading (P＜0.05); hPED-VFI was significantly negatively correlated with retreatment frequency within 24 months post-loading (standardized β=?0.513, P＜0.05). ConclusionsEarly volumetric fluctuation patterns can assess long-term treatment requirements in nAMD. Greater total fluid fluctuation predicts more frequent retreatments, while greater SHRM and hPED fluctuation predicts fewer retreatments.