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POOR RESPONDERS TO BEVACIZUMAB PHARMACOTHERAPY IN AGE-RELATED MACULAR DEGENERATION AND IN DIABETIC MACULAR EDEMA DEMONSTRATE INCREASED RISK FOR OBSTRUCTIVE SLEEP APNEA

Nesmith, Brooke LW MD, JD; Ihnen, Mark MD; Schaal, Shlomit MD, PhD

doi: 10.1097/IAE.0000000000000247
Original Study
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Purpose: To investigate the risk for obstructive sleep apnea (OSA) in patients with exudative age-related macular degeneration (AMD) or diabetic macular edema with poor response to anti-vascular endothelial growth factor therapy with bevacizumab (Avastin).

Methods: Age-related macular degeneration group was categorized into nonexudative, exudative, or poor response exudative. Diabetic macular edema group included patients with nonproliferative diabetic retinopathy and cystoid macular edema. Patients were categorized based on the number of intravitreal injections of bevacizumab received. Both groups were compared with age-matched controls. Patients completed a screening questionnaire to assess the risk for OSA, the main outcome measure.

Results: Of 103 patients with AMD, 56 (54.37%) had nonexudative AMD and 47 (45.63%) had exudative AMD, of which 14 (29.79%) had poor response exudative AMD and were at a significantly higher risk of OSA (P < 0.05). Of 30 diabetic macular edema patients with cystoid macular edema, 4 (19%) received 1 injection, 18 (81.82%) received 2 or more consecutive injections, and 16 (72.73%) received 3 or more consecutive injections. Risk for OSA increased significantly with increasing number of injections (P < 0.05).

Conclusion: Patients with exudative AMD and diabetic macular edema with poor response to anti-vascular endothelial growth factor therapy have a significantly higher risk of OSA compared with age-matched controls and should be screened to assess the risk of OSA.

Patients who show poor response to anti-vascular endothelial growth factor therapy for the treatment of exudative age-related macular degeneration or diabetic macular edema have a higher risk for obstructive sleep apnea compared with age-matched controls. Ophthalmologists should screen poor responders to anti-vascular endothelial growth factor therapy to assess their risk for obstructive sleep apnea.

Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky.

Reprint requests: Shlomit Schaal, MD, PhD, Department of Ophthalmology and Visual Sciences, University of Louisville, 301 E Muhammad Ali Boulevard, Louisville, KY 40202; e-mail: s.schaal@louisville.edu

Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, NY.

None of the authors have any conflicting interests to disclose.

© 2014 by Ophthalmic Communications Society, Inc.