Epidemiology of Intravitreal Injections in Iran: Indications and Referral Patterns in a Tertiary Hospital
Mohamad Zarei1 *, Hamid Riazi-Esfahani2 , Raziyeh Mahmoudzadeh2 , Mehdi Yaseri3 , Ramak Roohipoor2
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences,Tehran, Iran
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Abstract: To study the relative contribution of major indications and geographic referral
patterns for intravitreal bevacizumab injections in a tertiary hospital.
Methods: In this retrospective study, hospital electronic registry was used to categorize
patients who had received intravitreal injections (IVIs) during the 2014–2016 period into
different groups based on indications. Relative contribution of each indication and odds of
being resident of provinces other than Tehran were determined.
Results: The most prevalent indications for IVI were pathologies related to diabetes mellitus
(DM) followed by choroidal neovascularization (CNV)/age-related macular degeneration
(AMD) and retinal venous occlusion (RVO)-related complications. From 38,043 patients,
61.8% were residents of Tehran province. Patients in the CNV/AMD group were the oldest.
Patients from Tehran province were significantly older (62.44 ±11.42 (12–99)) than patients
who were referred from other provinces (59.23 ±11.39 (11–102)) (p=< 0.001). The majority
of patients in all indication categories were from Tehran province, except for patients with
retinopathy of prematurity (ROP). Odds of being referred from outside Tehran province for
the ROP group compared to the DM-related, CNV/AMD, RVO-related and miscellaneous
groups were 3.32, 4.27, 3.13 and 2.83, respectively (p<0.001).
Conclusion: DM-related ocular complications outnumber all other indications of IVIs
combined. Considering the preventable nature of these complications, efficient health policies
can significantly reduce the burden of IVIs in Iran. The contribution of each indication
category in overall burden of IVIs seems to vary considerably between different countries
which merits further studies. The disproportionately high ratio of ROP patients who are
referred from other provinces to the capital province for treatment indicates a suboptimal
distribution of ROP care services throughout the country.
