Profile of patients treated with intravitreal anti-vascular endothelial growth factor injections in Bhutan: a 3-year national survey

Purpose: Ocular vascular diseases are common causes of visual impairment and blindness, for which intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) is the first-line therapy. Current study describes the profile of patients receiving intravitreal anti-VEGF injections in Bhutan. This is the first study of its kind to inform the national health policy. Methods: For this retrospective study, we reviewed the surgical registers of the vitreoretinal unit across Bhutan over three years. Patient demography, clinical findings, diagnostic tests performed, and diagnoses or indications for intravitreal anti-VEGF injections were logged. A descriptive analysis was performed. Results: A total of 381 patients received intravitreal anti-VEGF injections in the operating theatres as mandated by the national guidelines. The majority of patients were males (230, 60.4%). The mean age was 65.2 {+/-} 13.5 years, ranging from 13 to 90 years, and a median of 69 years. Majority of the treated eyes (117, 30.7%) had BCVA <3/60 to light perception (PL), and another 51 eyes (13.4%) had < 6/60 to 3/60. The most common indication for anti-VEGF injection was neovascular AMD (168 cases, 42.2%), followed by retinal vein occlusion (132 cases, 34.6%), diabetic macular oedema and retinopathy (50 cases, 13.1%), and myopic choroidal neovascular membrane (11 cases, 0.03%). Conclusions: Bhutan faces both economic and geographic challenges, on top of limited human resources for managing vitreoretinal diseases. With an ever-increasing load of vitreoretinal diseases, and systemic diseases like diabetes and hypertension, there is a need to improve vitreoretinal services. Regular vitreoretinal services are provided only at the national referral hospital located in the north-west. For successful management, an effective community screening program, right referrals, and proper transport facilities must go hand-in-hand, and or extend regular vitreoretinal services to regional referral hospitals.