Author: Andrea Montesel (Italy)
Co-authors: Andrea Montesel, Anthony Gigon, Clarice Giacuzzo, Irmela Mantel, Chiara Eandi
Purpose
To investigate the visual and anatomical impact of treatment deferral during the COVID-19 lockdown on patients affected by neovascular age-related macular degeneration (nAMD) in a tertiary clinical setting.
Setting/Venue
Medical Retina Department, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
Methods
A retrospective case series of patients that were scheduled to receive intravitreal (IVT) injections treated according to the Observe-and-Plan (O&P) regimen during the Swiss lockdown (16th March - 26th April). Two groups of patients were included: patients that continued to receive their scheduled IVT treatment without clinical consultation (Group Continue 'C'), and patients for whom the IVT injections were completely deferred until the end of the lockdown (Group Stop, 'S'). Functional and anatomical parameters were collected based on optical coherence tomography (OCT) scans at four different time points, before (T-1, T0) and after (T1, T2) the lockdown.
Results
394 eyes of 314 patients were included, with 215 eyes in group C and 179 eyes in group S. In group C, baseline best available visual acuity (VA) was 0.29 ± 0.32 logMAR (20/40 Snellen equivalent) and it did not change significantly after the lockdown, being 0.30 ± 0.36 logMAR at T1 (20/40, p=.083). In group S, best available VA was respectively 0.32 ± 0.41 (20/40) and 0.40 ± 0.43 logMAR (20/50) at the pre- and post-lockdown visits (p<.001) and slightly improved after the reprise of the treatment (0.39 ± 0.51 logMAR at T2, 20/50) but it did not recover to the values before the lockdown, being significantly worse in comparison to baseline (p<.001). Mean central subfield thickness (CST) remained stable at the pre- and post-lockdown visits in group C (288±89 µm and 294±88 µm respectively, p=.449) while it increased in group S from 278±65 µm to 322±106 µm after the lockdown (p<.001) and it returned to pre-lockdown values after treatment recover (281±78 µm, p=.365).
Conlusions
Our results showed that treating patients with an injection-only approach was effective in managing nAMD patients during the first COVID-19 pandemic lockdown, while patients that deferred their scheduled treatment showed partially irreversible deterioration of visual function. These results could help retina specialists to manage future pandemic scenarios by developing successful management strategies.
Financial Disclosure
None to disclose.
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