Author: Georgios N. Tsiropoulos (Switzerland)
Co-authors: Rodolphe Vallée, Daniela Gallo Castro, Aude Ambresin
Purpose
Intravitreal anti-Vascular Endothelial Growth Factor (VEGF) injections are the gold standard treatment for neovascular Age-related Macular Degeneration (nAMD, also known as wet AMD). Coronavirus disease 2019 (COVID-19) and the resulting confinement, led to a change in the clinical practice as many patients did not attend their programmed injection visits. Our purpose is to compare the functional and structural visual outcomes of patients that did not respect their intervals (group 1) and those who did (group 2).
Setting/Venue
Swiss Visio Montchoisi (Lausanne, Switzerland) and RétinElysée Ophthalmology Center (Lausanne, Switzerland).
Methods
Patients diagnosed with nAMD of any type (I, II, or III), that had intravitreal anti-VEGF injections, both before and after the period of confinement due to the COVID-19 pandemic, regardless if the programmed injection interval was respected or not, were included in the study, after signing an informed consent form. Best-corrected visual acuity (BCVA) changes between the first post- and last pre-confinement visit were assessed for each patient. An unfavorable functional or BCVA outcome was established if the post-confinement visit showed a ≥ 5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters BCVA loss compared to pre-confinement. Structural or optical coherence tomography (OCT) outcomes were assessed by OCT changes between the first post- and last pre-confinement visits. Reduction or stability of the intraretinal fluid (IRF), subretinal fluid (SRF), and pigment epithelium detachment (PED) post-confinement established a favorable structural outcome while an increase of the aforementioned values established an unfavorable structural outcome. The statistical significance level was set to 0.05.
Results
Patients that lost at least one scheduled injection (group 1, n=89, 109 eyes, favorable/unfavorable BCVA, and OCT outcomes: 64/45 and 53/56, respectively) of intravitreal anti-VEGF during confinement, had a 13.41% greater rate of unfavorable BCVA change and 38.27% greater rate of unfavorable OCT change than patients who respected their assigned interval (group 2, n=96, 122 eyes, favorable/unfavorable BCVA, and OCT outcomes: 88/34 and 106/16 respectively) (P = 0.04, P <0.0001, respectively). The rates of PED and IRF increase in the first post-confinement visit were significantly higher in group 1 than in group 2 (P = 0.0004 and 0.0374, respectively) with a relative increase of unfavorable OCT outcome of 200% and 66.67%, respectively. Multivariate analysis showed that a) intervals followed by patients (which differed from their assigned interval in some cases) and their b) BCVA pre-confinement were predictive factors for unfavorable BCVA changes. The more the patients deviated from their programmed injections, the higher the rate of unfavorable BCVA change (P = 0.03). The higher the BCVA pre-confinement, the higher the rate of unfavorable BCVA change (P = 0.02). Multivariate analysis failed to identify predictive factors for unfavorable OCT changes.
Conlusions
COVID-19 pandemic was a unique circumstance to analyze the importance of designated individualized injection intervals in wet AMD patients. It also allowed us to confirm the crucial role of maintaining continuity in the treatment with intravitreal anti-VEGF injections, in order to ensure the best functional and structural outcome for each patient. During a next confinement due to COVID-19, or circumstances similar to it, ophthalmologists need to ensure the continuity of injections for their patients.
Financial Disclosure
None
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