&lt;p&gt;Clinical Experience in the Administration of Intravitreal Injection Therapy at a Tertiary University Hospital in Jordan During the COVID-19 Lockdown&lt;/p&gt;

Saleh, Omar; Jammal, Hisham M.; Alqudah, Noor; Alqudah, Asem; Abu-Yaghi, Nakhleh

doi:10.2147/opth.s269179

Cited by 22 publications

(48 citation statements)

References 25 publications

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“…Saleh et al reported that intravitreal injections were safely delivered, without any know Covid-19 case transmission in a tertiary care clinic in Jordan, but clinical volumes were diminished due to patient fears regarding contracting the virus. 15 Moreover, those who did seek care had poorer presenting visual acuity. Two studies from Milan, Italy also documented decreased clinical (up to 71%) and injection (54–58%) volumes.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Effects of COVID-19-Related Deferral of Intravitreal Injection Visits

Ashkenazy¹,

Goduni²,

Smiddy³

2021

OPTH

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Purpose To determine secondary effects of the mandated COVID-19 pandemic closure period for elective treatment on non-elective, injection-based retina care and outcomes. Patients and Methods In this cross-sectional, retrospective analysis of a single-provider outpatient clinic across multiple satellites, consecutive patients returning for intravitreal injections (IVIs) of anti-vascular endothelial growth factor or corticosteroids were identified as “delayed” or “undelayed” during a six-week study interval during the COVID-19 pandemic that closely following a mandated period of prohibited elective encounters. A “delayed” encounter was defined as having a follow-up interval exceeding 33% of the recommended cycle. Patients seen for IVIs during the corresponding six-week interval a year previously were identified for study as pre-COVID-19 controls. Main outcome measures included best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) assessment based on findings of intraretinal or subretinal fluid consistent with new or recurrent neovascular events. Results The study included 183 eyes of 144 patients who underwent IVI-based care from June 18, 2020, through August 7, 2020, compared to 193 eyes of 154 patients injected during the corresponding interval 1 year before. There were 62 eyes of 46 patients seen in the study period later than scheduled (among 144 patients of 183 eyes in total), which represented a larger proportion of delayed patients compared to the previous year (31.9% vs. 14.9%, p<0.0005). Considering the patterns from the control group, the attributed delay due to COVID-19 was 15.0% of patients. The delayed return eyes had a greater decline in BCVA (3 letters), higher rates of worsened OCT results (48%), and prompted reduction in previously prescribed injection intervals (p<0.02). Conclusion The unintended consequence of delayed care of patients on established care regimens should be anticipated, and mitigate strategies considered if similar restrictions are mandated in the future.

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Section: Discussionmentioning

confidence: 99%

Short-Term Effects of COVID-19-Related Deferral of Intravitreal Injection Visits

Ashkenazy¹,

Goduni²,

Smiddy³

2021

OPTH

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“…Both randomised controlled trials and real-world data analyses have demonstrated the benefit of anti-VEGF injections in the treatment of medical retina conditions. Studies suggest that without intravitreal treatment, there will be a significant deterioration in patients’ vision [ 6 – 9 ]. With this evidence, it can be predicted that the delays to anti-VEGF treatment attributed to COVID-19 will have a significant negative impact on visual outcomes.…”

Section: Introductionmentioning

confidence: 99%

Delayed follow-up of medical retina patients due to COVID-19: impact on disease activity and visual acuity

Stone

Grinton

Talks

2021

Graefes Arch Clin Exp Ophthalmol

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Purpose The coronavirus pandemic has prompted unprecedented delays to treatment with anti-VEGF intravitreal injections due to the need to reduce hospital attendances and prioritise the patients at highest risk of vision loss. This study aims to quantify the effect of these delays on visual acuity (VA) outcomes and optical coherence tomography (OCT) features for patients receiving treatment for neovascular age-related macular degeneration (nAMD), retinal vein occlusions (RVO) and diabetic macular oedema (DMO) and correlate to the Royal College of Ophthalmologists guidelines (RCOphth). Methods A retrospective data analysis of an electronic medical record was performed on a random sample of eyes receiving anti-VEGF injections for nAMD, RVO or DMO. Data collected included age, sex, reason for injection, number of weeks delay if > 8 weeks from that planned, VA at baseline and follow-up and the OCT features, if delayed. For those eyes not delayed, a visual acuity at 20 weeks was recorded to provide a control group. Results A sample of 981 eyes (858 patients) were analysed. There was a delay in review of 8 weeks or more in 39.6% of patients of which 30.4% had since returned for review (28.4% nAMD, 37.6% RVO and 30.0% DMO). There was no demographic difference identified between the delayed and non-delayed patients; however, the delayed group was significantly more likely to have better vision in their non-treated eye (p = 0.0003). A statistically significant difference was found in the change in VA between the delayed and the not-delayed group for eyes with nAMD (p = 0.001) but not for RVO or DMO. For the delayed group, mean CMT increased by 33 and 100 μm, respectively, for nAMD and RVO and decreased by 7.8 μm for DMO. The VA of 89.7% of DMO eyes returned to baseline, compared to 74.6% and 76.9% of nAMD and RVO eyes. Conclusion The RCOphth guidance to prioritise intravitreal injections for nAMD over DMO appears appropriate in this cohort but not for RVO. Eyes with nAMD experienced the greatest loss of vision with treatment delay, and nAMD and RVO eyes were less likely to return to baseline on restarting treatment.

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“…The pandemic changed the whole world. Since social distancing is a key measure to slow the transmission of the virus, in many countries, governments decided to implement lockdowns [4][5]. Although necessary to control the pandemic, these measures have resulted in major interruptions in the economy, social life, and healthcare provision [4].…”

Section: Introductionmentioning

confidence: 99%

Effect of COVID-19-Associated Lockdown on Patients With Diabetic Retinopathy

Chatziralli¹,

Dimitriou²,

Kazantzis³

et al. 2021

Cureus

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To evaluate the effect of the coronavirus disease 2019 (COVID-19)-related lockdown in the management of patients with diabetic retinopathy (DR), including diabetic macular edema (DME), in a tertiary reference center in Greece. MethodsIn this retrospective study, we first compared the number of patients who were diagnosed with DR or DME in our clinic during the period of the lockdown and during the same period of the previous year. In addition, we included consecutive patients with DR or DME, who were followed up and treated regularly in our clinic and their appointments deferred due to lockdown, so as to compare the visual acuity, fundoscopy, and optical coherence tomography (OCT) findings prior to and post lockdown. ResultsDuring the lockdown period, there was a statistically significant decrease in patients with DR and DME as compared to the same period in the previous year. Regarding patients with previously diagnosed DME, there was a statistically significant worsening in their visual acuity and central retinal thickness after lockdown as compared to the last visit before lockdown (p<0.001 for both comparisons). Concerning patients diagnosed with DR and without DME before lockdown, 30% of patients with severe non-proliferative diabetic retinopathy (NDPR) and 8.3% of patients with quiescent proliferative DR (PDR) progressed to active PDR while four out of 107 patients (3.7%) developed DME during the lockdown. Multivariate regression analysis revealed that only the time interval between the last visit before lockdown and the first visit after the lockdown was associated with the best-corrected visual acuity (BCVA) change (p=0.017). ConclusionsThe COVID-19-related lockdown was related to the postponement in patient care, which resulted in significantly worse visual acuity outcomes in patients with DR.

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<p>Clinical Experience in the Administration of Intravitreal Injection Therapy at a Tertiary University Hospital in Jordan During the COVID-19 Lockdown</p>

Cited by 22 publications

References 25 publications

Short-Term Effects of COVID-19-Related Deferral of Intravitreal Injection Visits

Short-Term Effects of COVID-19-Related Deferral of Intravitreal Injection Visits

Delayed follow-up of medical retina patients due to COVID-19: impact on disease activity and visual acuity

Effect of COVID-19-Associated Lockdown on Patients With Diabetic Retinopathy

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