Author: Komala Vadivelu (United Kingdom)
Co-authors: Kadambari Oswal
Purpose
To study the Vitreoretinal (VR) emergency service during the first wave of COVID-19 Pandemic. To highlight additional processes needed in order to provide emergency VR service. To also compare the VR emergency procedures and post-operative complications during COVID to a similar time period in the previous year (2019).
Setting/Venue
Retrospective case study of VR emergencies during COVID-19 Pandemic lockdown. Emergency Eye Clinic (EEC), Darlington memorial hospital (DMH), County Durham and Darlington Hospitals NHS Foundation Trust (CDDFT) UK. Pre-operative assessment: DMH, Bishop Auckland Hospital (BAH) CDDFT . Operating theatre: General Anaesthetics at DMH, Local Anaesthetics at BAH Post-operative care and visits: EEC DMH, outpatients eye clinic BAH. Personal protective equipment (PPE) fitting and training: DMH, BAH.
Methods
This is a retrospective case study of primary VR emergencies during initial COVID-19 pandemic lockdown at CDDFT catering for approximately 600,000 population in North-east of England. A total of 55 primary VR patients [(55 eyes)(28 males and 27 females)] treated from 25/03/2020 to 31/07/2020 were included. Of the 55 patients, 22 had retinal detachment (RD) who underwent RD Surgery, 23 had retinal breaks treated with retinopexy (22 laser-retinopexy,1 cryoretinopexy) and 10 had diabetic-related vitreous haemorrhage/tractional RD (TRD) who underwent vitrectomy/delamination. Work-up and management of patients was undertaken with full PPE. All patients tested COVID negative before the procedure. A single VR surgeon (KO) performed all RD procedures. We compared VR emergencies managed during the same time-period in 2019 which included 57 eyes of 57 patients (33 males, 24 females) of which 31 had retinal breaks treated with laser/cryoretinopexy, 13 had RD who underwent RD surgery and 13 had vitrectomy/delamination for vitreous haemorrhage/TRD secondary to diabetes mellitus. Two VR surgeons performed vitreoretinal procedures in 2019.
Results
During COVID-19 pandemic in 2020, of the 22 patients who had RD surgery, 21 patients had better post-operative Snellen visual acuity (VA) with 15 patients 6/9 or better, 5 between 6/12 to 6/24 and one less than 6/24. One had drop in VA from immediate post-op VA of 6/9 to 6/18 due to cataract. One patient had post-operative macular edema which resolved with topical therapy and one hypotony, needing reinjection of gas. During 2019, of the 13 patients who underwent RD surgery, all 13 patients had better post-op VA, with 8 patients 6/9 or better and 5 patients had VA less than 6/24. Three cases has retinal redetachment needing further surgery. Although there was no significant difference in the overall number of VR cases during COVID 2020, the primary RDs needing surgery increased by 169%. Lesser number of retinal breaks were seen during COVID 2020 as compared to the same period in 2019. Anatomical success rate of retinal attachment with first surgery was 100% (22 eyes) during COVID 2020. In 2019 anatomical success rate of retinal attachment with first surgery was 77% and with second surgery was 92%. There were no COVID related complications encountered in our patients.
Conlusions
Total number of primary VR patients seen during COVID lockdown in 2020 was similar to previous year. Increased number of RD and retinal detachment procedures by 169% during COVID maybe because of patients failing to present early at the stage of retinal breaks for prophylactic retinopexy. Our cohort of patients did not have any COVID related complications.
Financial Disclosure
No financial disclosure for all authors
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