Author: Daniela Rego-Lorca (Spain)
Co-authors: Alicia Valverde-Megías, Jose-Ignacio Fernández-Vigo, Julia Sánchez-Quirós, Carlos Oribio, Juan Reche-Frutos, Juan Donate-López
Purpose
To describe functional and structural effect of intravitreal treatment delay in patients with exudative age related macular degeneration (eAMD) type 3 during COVID pandemia.
Setting/Venue
Hospital Clínico San Carlos, Madrid, Spain.
Methods
Consecutive observational case series of patients diagnosed with eAMD type 3 in our Hospital whose follow-up and treatment was interrupted by COVID pandemic. Best corrected visual acuity (BCVA) in ETDRS letters, Heidelberg Spectralis OCT image and antiVEGF used were included for analysis in the visit before the onset of COVID pandemia in Spain (named covid-1), the visit before covid-1 (covid-2) and the visit when follow-up was resumed (covid-0). For each patient, real delay in days (from scheduled visit to actual visit after COVID onset) was calculated. Year of diagnosis of eAMD and number of antiVEGF injections one and two years before lockdown are shown. Inclusion criteria: difference from visit covid-1 to covid-0 of at least three months. Exclusion criteria: visual acuity of counting fingers or less before lockdown, loading dose uncompleted before lockdown, causes of choroidal neovascularization other than AMD.
Results
56 eyes of 47 patients met inclusion criteria. 11 were men (23,4%). Mean age was 83,8 years (SD 5,4). 30 eyes were treated with ranibizumab (53,5%), 12 eyes with aflibercept (21,4%) and 14 with bevacizumab (25%). The mean number of antiVEGF injections received the year prior to COVID lockdown was 5,1 (SD 1,7) and the year before was 3,7 (SD 2,8). Mean real delay was 107,8 days (SD 57,3; range 28-298). BCVA at diagnosis was 60,5 letters (SD 18,1), at covid-2 was 60,7 (SD 16,6), at covid-1 was 59,9 (SD 16,8) and at covid-0 was 55,5 (SD 19,2). The difference of 4.4 letters in BCVA before and after COVID were statistically significant (p=0.01) whereas difference of 0,9 letters between covid-2 and covid-1 were not (p=0,44) Structural OCT was described as active in covid-2 in 35 eyes (62,5%), in covid-1 in 35 eyes (62,5%) and in covid-0 in 44 eyes (78,6%, difference statistically significant, p=0.04). Mean central retinal thickness (CRT) in covid-2 was 294,9 (SD 141,5), in covid-1 was 295,9 (SD 161,5) and in covid-0 was 347,5 (SD 210; difference 51,6 microns, p=0.001) with an increase of eyes with both intra and subretinal fluid compared to before COVID lockdown.
Conlusions
In eAMD type 3 eyes, delay imposed by COVID pandemic resulted in visual loss not attributable to natural history of the disease, an increased percentage of active OCT, increase in mean CRT and reappearance of subretinal fluid added to intraretinal fluid. Further studies are warranted to measure how much of that visual loss will be reversible with proper continuous follow-up and treatment.
Financial Disclosure
Alicia Valverde-Megías and Juan Donate López: Novartis medical lectures
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