Modifications of intravitreal injections in response to the COVID-19 pandemic

Abstract

The Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruption to the normal operation of the healthcare system. On a worldwide scale, hospitals suspended nonurgent surgeries and outpatient visits to downsize clinical loadings to redistribute manpower to counteract the pandemic’s impact. So far, there is no evidence-based guideline defining a clear line between urgent and nonurgent indications of intravitreal injections (IVI). Herein, we aimed to summarize IVI algorithm modifications and discuss the patient prioritization according to medical needs in the hostile environment in the COVID crisis. Assessing current literature, we found that neovascular age-related macular degeneration is considered the utmost priority among conditions that require IVI. Other conditions assigned with a high priority include monocular or quasi-monocular patients (only one eye > 20/40), neovascular glaucoma, and new patients with significant vision loss. Although patients with central retinal vein occlusion and proliferative diabetic retinopathy are not advised to delay treatments, we found no consistent evidence that correlated with a worse outcome. Diabetic macular edema and branch retinal vein occlusion patients undertaking treatment delay should be regularly followed up every 2 to 3 months. Serving as the principle of management behind the algorithm modifications, the reduction of both patient visit and IVI therapy counts should be reckoned together with the risk of permanent visual loss and COVID infection.

Same-Day Bilateral Intravitreal Dexamethasone Implants for the Treatment of Diabetic Macular Edema

“…The COVID-19 pandemic was a serious public health crisis at the time this study initiated. The pandemic has greatly decreased the administration of nonurgent procedures, resulting in the suspension or delay of intravitreal therapies [8, 9, 21]. Ryder et al [17] reported a mean interval of 15.6 days (range: 2–71 days) between DEX implantation in the initial eye and subsequent DEX implantation in the fellow eye.…”

The management of neovascular age‐related macular degeneration: A systematic literature review of patient‐reported outcomes, patient mental health and caregiver burden

“…Communication and co‐created treatment goal‐setting is obviously key, but can be complicated by hearing and/or cognitive impairment in this elderly population. Additionally, while several recent studies have investigated the effect of the COVID‐19 pandemic on treatment regimens and vision in nAMD (Arruabarrena et al, 2021 ; Bulut et al, 2021 ; Weng et al, 2021 ), we should also remember the impact of the recent pandemic on the mental health of our patients and our ability to provide the required level of physician–patient interaction.…”

Impact of Covid-19 Pandemic Lockdowns on Visual Acuity of Patients With Neovascular Amd

“…Nevertheless, although we demonstrated no significant difference in vision loss because of those restrictions in a large cohort of patients, other studies have shown significant changes in BCVA or optical coherence tomography outcomes. [16][17][18][19][20] Possible explanations for this may be the size of the cohorts or the treatment regimen, which is mostly treat and extend, whereas other countries may apply monthly regimen, which may increase the difference in visual acuity because of an unplanned long break. Considering the above, it seems like the biggest unplanned added gap between anti-VEGF injections was two months long for most subjects, with a stable recovery since then.…”