Purpose: To describe the clinical experience with the delivery of intravitreal injection therapy to patients with various indications at a tertiary university hospital during the COVID-19 lockdown in Jordan. Methods: This is a retrospective observational study of patients who received intravitreal injections between April 12th and May 9th, 2020, a period during the national COVID-19 lockdown (March 16th to June 6th, 2020). Special medical and logistic arrangements, priority and visual risk assessment and strict infection control precautions were implemented. Demographics, diagnosis, intravitreal injection history, medical history, ophthalmic examinations and optical coherence tomography data were collected and analyzed. Results: Intravitreal injections were successfully administered to 132 patients with diabetic retinopathy, age-related macular degeneration and retinal vein occlusion. All logistic and transmission control measures were followed by the medical staff and patients with no incidents. No new exposures or COVID-19 positive cases were traced to our location or time of therapy. No complications related to the injections were recorded. The mean period of delay due to the lockdown from the original scheduled appointment was six weeks. Mean visual acuity significantly decreased from 20/55 before the lockdown to 20/70 after the lockdown, and mean central macular thickness significantly increased from 329 to 370 μ. Conclusion: The administration of intravitreal injection therapy during the COVID-19 lockdown under special safety precautions was feasible and successful. Resumption of the essential therapies and medical services during periods of pandemic restrictions while adhering to strict transmission control measures is encouraged.

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Purpose To determine the association of vision-related quality of life to demographic factors and visual function in glaucoma suspect or early glaucoma patients.. Methods We administered the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) on the same day as a comprehensive ocular examination to participants either with glaucoma or at high risk for developing glaucoma. Regression models were used to determine the association between VFQ-25 composite and subscale scores, VF status, logMAR equivalent VA, age and gender. In all analyses we used data from the eye with the best Mean Deviation (MD), best Pattern Standard Deviation (PSD) and best VA. Results Data from 198 participants were analyzed. The mean best MD (± standard deviation) was 0.02 ±1.52dB (range; −5.11 to 2.63) and the mean best PSD was 1.75 ±1.03dB (range; 0.91 to 8.36). The mean VFQ-25 composite score was 91.6 ±6.7 (range; 54.5 to 100.0). Composite score, and the distance activities and color vision subscale scores were associated with best MD (p≤0.05). The general vision and driving subscale scores were associated with best VA (p≤0.03). The composite score and the distance activities, driving and color vision subscale scores were associated with age (p≤0.05). Finally, the distance activities, driving and peripheral vision subscale scores were associated with gender (p≤0.04). Conclusions Vision-related quality of life is associated with visual field status even in early and suspected glaucoma. It is also associated with VA, age and gender. Particular decreases in quality of life are related to distance activities, driving and color vision.

Purpose: The purpose of this study was to compare the clinical outcomes from using eye bank–prepared, endothelium-out preloaded Descemet membrane endothelial keratoplasty (DMEK) tissue with those obtained with endothelium-out surgeon-loaded DMEK tissue using the same surgical technique at 1 site. Methods: This study retrospectively reviewed 400 consecutive cases of DMEK from March 2016 to April 2018. The last 200 cases using surgeon-loaded tissue were compared with the first 200 cases using preloaded tissue. Statistical analysis was performed using the Wilcoxon signed-rank test, binomial logistic regression, Kruskal–Wallis 1-way analysis of variance, Student t test, or Pearson χ2 tests. Results: Comparing surgeon-loaded versus preloaded DMEK tissue, respectively, no statistical difference was found in the mean 6-month postoperative values for endothelial cell loss (32.9% ± 18.5% vs. 29.9% ± 16.4%, P = 0.31), best corrected visual acuity (20/26 vs. 20/25, P = 0.54), or change in central corneal thickness (−14.4% ± 8.9% vs. −15.6% ± 11.7%, P = 0.43). The mean 1-year endothelial cell loss was also not significantly different (37.6% ± 17.2% vs. 33.2% ± 14.8%, P = 0.07). Overall, the rebubble rate for surgeon-loaded tissue was 17.5% and 12.5% for preloaded tissue, a statistically nonsignificant difference. Operative outcomes for mean tissue scroll tightness (1–4) and tissue unscroll time (minutes) for surgeon-loaded and preloaded tissue were similar between groups (2.4 vs. 2.2, P = 0.12 and 3.5 vs. 3.3 minutes, P = 0.50). Conclusions: Tissue that is trephinated, stained, and loaded into an injector by the eye bank and then shipped to the surgeon had no difference in clinical outcomes compared with tissue where the surgeon performs these steps. The safety and speed of using preloaded tissue should be considered by DMEK surgeons.