ABSTRACT
Purpose : To assess cryopreserved (C-AM) versus sterilized chorion-free freeze-dried (FDAM) amniotic membranes overlay transplantation for corneal epithelial defects in a French tertiary ophthalmology hospital Methods : Between March and July 2020, when C-AM were not available due to the COVID19 pandemic and to the national lockdown, 28 corneal ulcers underwent FD-AM overlay transplantation and were retrospectively compared to 22 corneal ulcers treated with C-AM during the same period in 2018. All patients had at least 3 months of follow-up and those who underwent combined surgeries were excluded. Ulcers were assessed at baseline and then at 1 and 3 months. Population demographics, follow-up time, ulcer etiologies, ulcer size, and complications were also recorded. Results : Baseline characteristics and clinical features of both groups were comparable. There was no statistically significant difference in the number of overlay amniotic membrane transplantations (p= 0.52) or early fall (p=0.57). At 3 months, the corneal healing rate was almost the same in both groups (89% and 91% for FD-AM and C-AM, respectively;p=0.85). Complications were evenly unusual (11% and 9% respectively;p=0.92). In logistic regression, the nature of the membrane did not influence corneal healing at 1 month (p=0.42) and 3 months (p=0.99) regardless of the depth of the ulcer. However, whatever the type of AM used, the deeper the ulcer was, the less likely it was to heal at 3 months (p=0.02). Conclusions : This first study provides positive insight into the effectiveness of FD-AM as compared to C-AM when used as overlay transplantation for treating corneal ulcers.
ABSTRACT
PURPOSE: This study aimed to evaluate the ability of a freely accessible internet algorithm to correctly identify the need for emergency ophthalmologic consultation for correct diagnosis and management. METHOD: This retrospective observational cohort study was based on the first 100 patients who requested recommendations on the necessity of breaking the lockdown for emergency ophthalmology consultation during the period from March to May 2020. RESULTS: Ninety-one patients completed questionnaires. Forty-nine were directed to emergency consultation and 42 to differed scheduled visits or telemedicine visits. One patient sent for emergency consultation had an overestimated severity and could have been seen later, while two patients initially recommended for a scheduled visit were considered appropriate for emergency consultation. However, these patients' management did not suffer as a consequence of the delay. The sensitivity of the algorithm, defined as the number of emergency consultations suggested by the algorithm divided by the total number of emergency consultations deemed appropriate by the practitioner's final evaluation, was 96.0%. The specificity of the algorithm, defined as the number of patients recommended for delayed consultation by the algorithm divided by the number of patients deemed clinically appropriate for this approach, was 97.5%. The positive predictive value, defined as the number of appropriate emergency consultations divided by the total number of emergency consultations suggested by the algorithm, was 97.9%. Finally, the negative predictive value, defined as the number of appropriately deferred patients divided by the number of deferred patients recommended by the algorithm, was 95.2%. CONCLUSION: This study demonstrates the reliability of an algorithm based on patients' past medical history and symptoms to classify patients and direct them to either emergency consultation or to a more appropriate deferred, scheduled appointment. This algorithm might allow reduction of walk-in visits by half and thus help control patient flow into ophthalmologic emergency departments.