ABSTRACT
Purpose : Selective laser trabeculoplasty (SLT) has been widely used as both a primary and adjunct treatment in glaucoma. Glaucoma surgery was significantly affected during the Covid-19 pandemic due to reduced theatre and clinic capacity. We looked at SLT as a temporary alternative to safely delay surgical intervention in presurgical primary open angle glaucoma (POAG). Methods : This is a retrospective study that included 104 patients who had a diagnosis of POAG and received SLT treatment, with at least 1 year follow-up. Primary outcomes included: reduction in intraocular pressure (IOP), and number of glaucoma medications (NGM). The endpoint was defined as time to be listed for glaucoma surgery. All eyes that had progressive or advanced visual fields and were on 2 or more medications were included. Eyes with previous glaucoma filtration surgery or argon laser trabeculoplasty, diagnosed with normal tension glaucoma or that had significant angle closure disease (peripheral anterior synechiae >180) were excluded. Results : The mean patient age was 73.4 ± years. At baseline, the mean IOP and NGM were 20.5 ± 4.9 and 2.8 ± 0.9 mmHg, respectively. At 12 months, the mean IOP was 16.5 ± 3.3 mmHg and the NGM was 2.7 ± 1.0. The IOP reduction was 3.7 ± 5.8 mmHg (14.5%, p<0.01) at 12 months follow-up, 3.4 ± 4.7 mmHg (15.5%, p<0.01) at 24 months follow-up, 3.7 ± 5.2mmHg (15.2%, p<0.01) at 36 months follow-up and 2.5 ± 5.9 mmHg (10.1%, p=0.04) at 48 months follow-up. No surgical intervention was needed in 96% of eyes within the first year of SLT. There was no significant difference in the NGM pre- and post- SLT. Conclusions : With the current pandemic limiting the surgical capacities of eye hospitals, SLT can safely delay the need for glaucoma surgery for at least 1 year by reducing the IOP. This is particularly apparent in elderly patients or those poorly compliant to medical therapy. In addition, this could increase ophthalmology clinic capacity by reducing the number of post-operative follow ups.
ABSTRACT
Purpose The impact of COVID 19 on lung donors and lung transplant recipients in Australia has not been studied. This study followed the impact of COVID 19 in the initial Australian COVID 19 surge. Methods This was a retrospective cohort study which examined data from the centre's local CPRS transplant database, Australia and New Zealand Organ Donation Registry and hospital medical records from 01st Jan 2017 to 31st August 2020. Organ donation patterns, cause of donor deaths, recipient characteristics and transplant surgery volumes were monitored. Results Over the 8 months, from 1st of January to 31st August, there were 26 lung transplants in 2020 compared to 35 in the same period in 2019 at the centre. Suicide and overdose became 2.65 times more likely as causes of donor death at the centre and 1.60 times more likely nationally. Heart attack and stroke became less likely causes of donor death. Lung transplant recipients were more likely to have a diagnosis of pulmonary fibrosis, but had on average improved measures of pre-surgical frailty and improved operative outcomes. The exception to this was ICU time and ventilatory time, which increased on average. MOCA scores improved on average, suggestive of better mental acuity. Indicators of mental health were worse in the 2020 cohort, based on the average dmi10 depression screening score. Conclusion There was a 69.23% decline in volume of organ transplantation as of August 2020. With the initial surge of cases the transplant volumes decreased dramatically, however with “lockdown” and control of “COVID cases” the lung transplant rates increased. The Victorian outbreak from August further diminished rates of transplant due to travel restrictions, however the NSW based unit managed to maintain lung transplant levels with local donors and minor interstate referrals. An increase in physical robustness corresponds to increased referral and uptake of “prehabilitation” by waitlisted patients.