Author: Bruna Cunha (Portugal)
Co-authors: Pedro Gil, Diogo Maleita, Miguel Marques, Margarida Marques, Rita Flores
Purpose
To investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic in the management and compliance of newly diagnosed treatment-naïve with exudative macular disease [mainly neo-vascular age-related macular degeneration (nAMD), diabetic macular oedema (DME) and retinal vein occlusions (RVO)] or proliferative diabetic retinopathy (PDR), and secondarily its impact on the disease progression.
Setting/Venue
Medical Retina Unit, Ophthalmology Department – Central Lisbon Universitary Hospital Centre
Methods
125 consecutive patients with diagnosis of nAMD, DME, RVO and PDR requiring intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections for the first time, were consecutively enrolled between March 1, 2020, and October 31, 2020, (representing the COVID-19 group). 125 patients presenting between January 1, 2019 and August 31, 2019 (pre-COVID-19 group) meeting the same criteria, were also included for comparison. The number of injections, ophthalmology visits, intervals between them, absences and their reasons, and eventual loss of follow-up, within 6 months after the first injection were assessed for each patient. Best-corrected visual acuity (BCVA) and structural changes to the retina using ocular coherence tomography (OCT) were obtained before and 6 months after the first injection. The two groups were compared to establish if COVID-19 was connected to any treatment delay or loss of follow-up. The BVCA and OCT findings were analysed to assess whether the pandemic resulted in worse visual and structural outcomes.
Results
A total of 250 eyes from 250 patients was included in the study (COVID-19 group: 125 eyes; pre-COVID-19 group: 125 eyes). The first was slightly younger (70.34±13.36 vs. 73.51±11.27; p=0.043). Indications for anti-VEGF treatment were similar in both groups (chi=1.712; p=0.887) and the majority included DME (29.6% in the COVID-19 group and 32.8% in the pre-COVID-19 group) and nAMD (28.8% in both groups). Throughout the 6-month follow-up period, the mean number of injections were significantly reduced in the COVID-19 group (3.08±1.36 vs. 3.54±1.20; p=0.005). The rate of loss of follow-up (for any reason) was smaller in the COVID-19 group (p=0.020). The median number of missed clinical visits or treatment sessions (for any reason) was smaller in the COVID-19 group (p=0.001). There was no significant difference in the interval between injections (COVID-19: 49.89±34.61; pre-COVID-19: 54.56±27.42 days; p=0.258). Baseline BCVA was similar in both groups (COVID-19: 0.71±0.45; pre-COVID-19: 0.74±0.47 logMAR; p=0.577). Baseline central retinal thickness was similar in both groups (COVID-19: 475.98±233.39; pre-COVID-19: 444.74±193.74 micrometres; p=0.287). BCVA improvement (COVID-19: -0.14±0.31; pre-COVID-19: -0.20±0.32 logMAR; p=0.202) and central retinal thickness reduction (COVID-19: -149.00±251.32; pre-COVID-19: -131.54±177.28 micrometers; p=0.575) after treatment were similar in both groups.
Conlusions
Despite the diminished number of intravitreal procedures, the COVID-19 pandemic proved to have no impact in the interval between injections, and there were fewer absences and follow-up losses during the COVID-19 period. This was probably a result of the well-established protocol in our ophthalmology department that prioritized this group of patients, as well as the raised awareness among the Portuguese population for the importance of not neglecting their medical comorbidities despite the pandemic. There were also no significant differences in the BCVA and OCT findings at presentation, supporting the theory that referrals for diagnosis and treatment were not delayed. Furthermore, the COVID-19 restrictions were not associated with worse functional or structural outcomes in these patients.
Financial Disclosure
None
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