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1.
Retina ; 42(3): 465-475, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1706662

ABSTRACT

PURPOSE: To describe clinical and ophthalmologic features and outcomes of patients with coronavirus disease-19 with retinal vascular occlusions. METHODS: Retrospective multicenter case series and PubMed review of cases reported from March 2020 to September 2021. Outcome measures are as follows: type of occlusion, treatments, best-corrected visual acuity, and central macular thickness on optical coherence tomography. RESULTS: Thirty-nine patients were identified. Fifteen patients with a median age of 39 (30-67) years were included in the multicenter study. Vascular occlusions included central retinal vein occlusion (12 eyes), branch retinal vein occlusion (4 eyes), and central retinal artery occlusion (2 eyes). Three cases were bilateral. Baseline best-corrected visual acuity was 20/45 (no light perception-20/20). Baseline central macular thickness was 348.64 (±83) µm. Nine eyes received anti-vascular endothelial growth factor agents, dexamethasone intravitreal implant, or both. Final best-corrected visual acuity was 20/25 (no light perception-20/20), and central macular thickness was 273.7 ± 68 µm (follow-up of 19.6 ± 6 weeks). Among the 24 cases from the literature review, retinal vein occlusion was the predominant lesion. Clinical characteristics and outcomes were similar to those found in our series. CONCLUSION: Coronavirus disease-19-associated retinal vascular occlusions tend to occur in individuals younger than 60 years. Retinal vein occlusion is the most frequent occlusive event, and outcomes are favorable in most cases.


Subject(s)
COVID-19/diagnosis , Eye Infections, Viral/diagnosis , Retinal Vein Occlusion/diagnosis , SARS-CoV-2/isolation & purification , Adult , Aged , Angiogenesis Inhibitors/therapeutic use , COVID-19/drug therapy , COVID-19/virology , COVID-19 Nucleic Acid Testing , Dexamethasone/therapeutic use , Drug Implants , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Female , Fluorescein Angiography , Glucocorticoids/therapeutic use , Humans , Intravitreal Injections , Male , Middle Aged , Retinal Vein Occlusion/drug therapy , Retinal Vein Occlusion/virology , Retrospective Studies , SARS-CoV-2/genetics , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology
3.
Ophthalmology ; 128(11): 1620-1626, 2021 11.
Article in English | MEDLINE | ID: covidwho-1510165

ABSTRACT

PURPOSE: Routine use of face masks for patients and physicians during intravitreal anti-vascular endothelial growth factor (VEGF) injections has increased with the emergence of the coronavirus disease 2019 pandemic. This study evaluates the impact of universal face mask use on rates and outcomes of post-injection endophthalmitis (PIE). DESIGN: Retrospective, multicenter, comparative cohort study. PARTICIPANTS: Eyes receiving intravitreal anti-VEGF injections from October 1, 2019, to July 31, 2020, at 12 centers. METHODS: Cases were divided into a "no face mask" group if no face masks were worn by the physician or patient during intravitreal injections or a "universal face mask" group if face masks were worn by the physician, ancillary staff, and patient during intravitreal injections. MAIN OUTCOME MEASURES: Rate of endophthalmitis, microbial spectrum, and visual acuity (VA). RESULTS: Of 505 968 intravitreal injections administered in 110 547 eyes, 85 of 294 514 (0.0289%; 1 in 3464 injections) cases of presumed endophthalmitis occurred in the "no face mask" group, and 45 of 211 454 (0.0213%; 1 in 4699) cases occurred in the "universal face mask" group (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.51-1.18; P = 0.097). In the "no face mask" group, there were 27 cases (0.0092%; 1 in 10 908 injections) of culture-positive endophthalmitis compared with 9 cases (0.004%; 1 in 23 494) in the "universal face mask" group (OR, 0.46; 95% CI, 0.22-0.99; P = 0.041). Three cases of oral flora-associated endophthalmitis occurred in the "no face mask" group (0.001%; 1 in 98 171 injections) compared with 1 (0.0005%; 1 in 211 454) in the "universal face mask" group (P = 0.645). Patients presented a mean (range) 4.9 (1-30) days after the causative injection, and mean logarithm of the minimum angle of resolution (logMAR) VA at endophthalmitis presentation was 2.04 (~20/2200) for "no face mask" group compared with 1.65 (~20/900) for the "universal face mask" group (P = 0.022), although no difference was observed 3 months after treatment (P = 0.764). CONCLUSIONS: In a large, multicenter, retrospective study, physician and patient face mask use during intravitreal anti-VEGF injections did not alter the risk of presumed acute-onset bacterial endophthalmitis, but there was a reduced rate of culture-positive endophthalmitis. Three months after presentation, there was no difference in VA between the groups.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , COVID-19/epidemiology , Disease Transmission, Infectious/prevention & control , Endophthalmitis/prevention & control , Eye Infections, Bacterial/prevention & control , N95 Respirators , Comorbidity , Endophthalmitis/epidemiology , Endophthalmitis/etiology , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/etiology , Follow-Up Studies , Incidence , Intravitreal Injections/adverse effects , Retinal Diseases/drug therapy , Retinal Diseases/epidemiology , Retrospective Studies , United States/epidemiology , Vascular Endothelial Growth Factor A/antagonists & inhibitors
4.
Retina ; 41(11): 2215-2220, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1483570

ABSTRACT

PURPOSE: To investigate the bacterial growth in the surgical face masks used by patients who received intravitreal injections and study the effect of povidone-iodine on the periocular area (PA) of masks. METHODS: Forty patients who attended for intravitreal injections were divided in those with less (<4 hours) and more (>4 hours) than 4 hours of mask use. Each group was divided depending on the application or not of povidone-iodine in the PA of the mask. Bacterial load was studied on PA and mouth area samples. RESULTS: The bacterial load in the PA was higher in the >4 hours group compared with the <4 hours group (13.2 vs. 48.75 colony-forming units/µL; P = 0.03). The contamination in the PA significantly decreased after applying povidone-iodine in the >4 hours group (P = 0.01). The use or not of povidone-iodine was strongly correlated to a positive culture (OR = 9.0, P = 0.00. CI 1.63-49.44). CONCLUSION: Surgical face masks worn for more than 4 hours present higher contamination in the PA than those with less use. Bacterial load in the PA is reduced with povidone-iodine on masks used for more than 4 hours. This contamination should be considered in the asepsis protocol of intravitreal injections.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , Bacteria/isolation & purification , COVID-19/epidemiology , Equipment Contamination , Masks/microbiology , SARS-CoV-2 , Aged , Aged, 80 and over , Anti-Infective Agents, Local/administration & dosage , Bacterial Load , Bacteriological Techniques , Female , Humans , Intravitreal Injections , Male , Middle Aged , Povidone-Iodine/administration & dosage , Prospective Studies , Retinal Diseases/drug therapy , Vascular Endothelial Growth Factor A/antagonists & inhibitors
5.
Retina ; 41(12): 2456-2461, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1348074

ABSTRACT

PURPOSE: To evaluate the outcomes of delay in care secondary to the coronavirus pandemic in patients requiring intravitreal anti-vascular endothelial growth factor therapy. METHODS: A retrospective review was performed, and subjects were divided into two groups: 1) a study group of patients who experienced a treatment delay of ≥6 weeks from the intended follow-up during the coronavirus pandemic and resumed treatment with ≥2 anti-vascular endothelial growth factor injections over 6 months following treatment delay, and 2) a control group of patients who received regular care throughout the coronavirus pandemic. RESULTS: Totally, 234 subjects were analyzed. The mean treatment delay from the intended follow-up in the study group was 11.8 (±4.0) weeks. Visual acuity and central macular thickness worsened from baseline to 6 months after resuming anti-vascular endothelial growth factor therapy in the study group (P < 0.0001 and P = 0.001, respectively). Visual acuity and central macular thickness were better in the control group compared with the study group at the end of the 6-month study period (P < 0.0001 for both). CONCLUSION: Treatment delay in subjects undergoing anti-vascular endothelial growth factor therapy for retina disease during the coronavirus pandemic had worse visual and anatomical outcomes despite reinitiating treatment over 6 months compared with a control group, suggesting irreversibility and permanence of outcomes.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , COVID-19/epidemiology , Retinal Diseases/drug therapy , SARS-CoV-2 , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Aged , Bevacizumab/therapeutic use , Choroidal Neovascularization/drug therapy , Choroidal Neovascularization/physiopathology , Continuity of Patient Care , Diabetic Retinopathy/drug therapy , Diabetic Retinopathy/physiopathology , Female , Humans , Intravitreal Injections , Macular Edema/drug therapy , Macular Edema/physiopathology , Male , Outcome Assessment, Health Care , Ranibizumab/therapeutic use , Retinal Diseases/physiopathology , Retinal Vein Occlusion/drug therapy , Retinal Vein Occlusion/physiopathology , Retrospective Studies , Time-to-Treatment , United States/epidemiology , Visual Acuity/physiology , Wet Macular Degeneration/drug therapy , Wet Macular Degeneration/physiopathology
6.
Ophthalmology ; 128(11): 1620-1626, 2021 11.
Article in English | MEDLINE | ID: covidwho-1275607

ABSTRACT

PURPOSE: Routine use of face masks for patients and physicians during intravitreal anti-vascular endothelial growth factor (VEGF) injections has increased with the emergence of the coronavirus disease 2019 pandemic. This study evaluates the impact of universal face mask use on rates and outcomes of post-injection endophthalmitis (PIE). DESIGN: Retrospective, multicenter, comparative cohort study. PARTICIPANTS: Eyes receiving intravitreal anti-VEGF injections from October 1, 2019, to July 31, 2020, at 12 centers. METHODS: Cases were divided into a "no face mask" group if no face masks were worn by the physician or patient during intravitreal injections or a "universal face mask" group if face masks were worn by the physician, ancillary staff, and patient during intravitreal injections. MAIN OUTCOME MEASURES: Rate of endophthalmitis, microbial spectrum, and visual acuity (VA). RESULTS: Of 505 968 intravitreal injections administered in 110 547 eyes, 85 of 294 514 (0.0289%; 1 in 3464 injections) cases of presumed endophthalmitis occurred in the "no face mask" group, and 45 of 211 454 (0.0213%; 1 in 4699) cases occurred in the "universal face mask" group (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.51-1.18; P = 0.097). In the "no face mask" group, there were 27 cases (0.0092%; 1 in 10 908 injections) of culture-positive endophthalmitis compared with 9 cases (0.004%; 1 in 23 494) in the "universal face mask" group (OR, 0.46; 95% CI, 0.22-0.99; P = 0.041). Three cases of oral flora-associated endophthalmitis occurred in the "no face mask" group (0.001%; 1 in 98 171 injections) compared with 1 (0.0005%; 1 in 211 454) in the "universal face mask" group (P = 0.645). Patients presented a mean (range) 4.9 (1-30) days after the causative injection, and mean logarithm of the minimum angle of resolution (logMAR) VA at endophthalmitis presentation was 2.04 (~20/2200) for "no face mask" group compared with 1.65 (~20/900) for the "universal face mask" group (P = 0.022), although no difference was observed 3 months after treatment (P = 0.764). CONCLUSIONS: In a large, multicenter, retrospective study, physician and patient face mask use during intravitreal anti-VEGF injections did not alter the risk of presumed acute-onset bacterial endophthalmitis, but there was a reduced rate of culture-positive endophthalmitis. Three months after presentation, there was no difference in VA between the groups.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , COVID-19/epidemiology , Disease Transmission, Infectious/prevention & control , Endophthalmitis/prevention & control , Eye Infections, Bacterial/prevention & control , N95 Respirators , Comorbidity , Endophthalmitis/epidemiology , Endophthalmitis/etiology , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/etiology , Follow-Up Studies , Incidence , Intravitreal Injections/adverse effects , Retinal Diseases/drug therapy , Retinal Diseases/epidemiology , Retrospective Studies , United States/epidemiology , Vascular Endothelial Growth Factor A/antagonists & inhibitors
8.
Retina ; 41(11): 2208-2214, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1219729

ABSTRACT

PURPOSE: To evaluate the rates of postintravitreal injection-related endophthalmitis during the COVID-19 pandemic with institution of both physician and patient face masking. METHODS: All eyes receiving intravitreal injections of any kind from a single large tertiary retina practice in Houston, TX before (August 2017-March 22, 2020) and after (March 23, 2020-September 2020) COVID-19 pandemic universal masking protocols. The total number of injections and cases of acute injection-related endophthalmitis were determined from billing records and subsequent retrospective chart review. The primary outcome was the rate of endophthalmitis after intravitreal injection. Secondary outcomes included visual acuity, time until initial presentation, patient age, and differences in the overall number of injections performed monthly pre-COVID-19 and post-COVID-19. RESULTS: A total of 134, 097 intravitreal injections were performed during the study period (111,679 pre-COVID-19 and 22,418 post-COVID-19 masking protocols). A total of 41 cases of acute endophthalmitis occurred in the pre-COVID group (0.04%, one in 2,500) and 7 cases in the post-COVID group (0.03%, one in 3,333) P = 0.85. CONCLUSION: In this single center, retrospective study, the implementation of universal patient and physician masking as practiced during the COVID-19 pandemic did not significantly affect the rate of postintravitreal injection endophthalmitis.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , COVID-19/epidemiology , Endophthalmitis/epidemiology , Intravitreal Injections/adverse effects , Masks/statistics & numerical data , SARS-CoV-2 , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Aged , Aged, 80 and over , Choroid Diseases/drug therapy , Eye Infections, Bacterial/epidemiology , Female , Humans , Male , Middle Aged , Retinal Diseases/drug therapy , Retrospective Studies , United States/epidemiology , Visual Acuity
9.
Indian J Ophthalmol ; 69(3): 730-733, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1089033

ABSTRACT

PURPOSE: The aim of this study was to analyze the impact on vision due to delay in presentation of patients requiring intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, consequent to COVID-19-related travel restrictions. METHODS: Data were collected retrospectively of patients who received anti-VEGF injections during four months of the COVID-19 pandemic. Visual acuities, indication for treatment were noted along with basic demographic characteristics. RESULTS: Data were analyzed for 303 eyes of 263 patients. The indication for treatment was age-related macular degeneration (AMD) in 60 eyes (19.8%), while 162 eyes (53.5%) had Diabetic Macular Edema, 71 eyes (23.4%) had Retinal Vein Occlusion and 10 eyes (3.3%) had other diagnosis. The visual acuity in the treatment naïve eyes (Group A, n = 168) was significantly worse (P <0.001) than those who presented for retreatment (Group B, n = 135). In Group B, there was a significant decline in vision for the entire cohort (P = 0.009) and those with AMD (P = 0.036). Those in Group B presented at a mean interval of 19.1 ± 10.6 (range, 4-64) weeks for retreatment. CONCLUSION: The COVID-19 pandemic has led to a delay in patients receiving anti-VEGF injections. The visual acuity is worse in both treatment naïve as well as those requiring retreatment. This could have long-term impact on vision of patients requiring this vision preserving treatment.


Subject(s)
Bevacizumab/administration & dosage , COVID-19/epidemiology , Quarantine , Ranibizumab/administration & dosage , Retinal Diseases/drug therapy , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , Comorbidity , Female , Follow-Up Studies , Humans , Intravitreal Injections , Male , Middle Aged , Retinal Diseases/epidemiology , Retrospective Studies , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Young Adult
10.
J Fr Ophtalmol ; 44(3): 299-306, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1078009

ABSTRACT

OBJECTIVES: To investigate the effects of the COVID-19 pandemic on the treatment course of neovascular age-related macular degeneration (nAMD) patients who received anti-VEGF injection therapy with real-life data. METHODS: This retrospective study consisted of 116 eyes of 106 patients. Ophthalmic examination, assessment of best-corrected visual acuity (BCVA), optical coherence tomography (OCT) findings and data of last two visits before restrictions (V-2 and V-1) and the first visit (V0) after the release of national lockdown and subsequent visits (V1 and Vlast) were recorded. The lockdown period was determined by the time interval between March 11 and June 1, 2020. MAIN RESULTS: The injection interval before V-1 was significantly longer than the interval after V0 (2.56±0.9 vs. 2.14±0.8 months, P=0.02). While the median central macular thickness (CMT) was significantly increased at V0 compared to V-1 [274(132-711) vs. 238(136-628), P<0.001], the median CMT was significantly lower at V1 compared to V0 [256 (136-591) vs. 274(132-711), P=0.003]. The median BCVA was 0.67(0.1-1.1) logMAR at V-1 and significantly worsened to 0.78 (0.1-1.2) logMAR at V0 (P=0.003). Although the median BCVA improved to 0.69 logMAR (0.1-1.2) at Vlast, the difference did not reach statistical significance compared to V0 (P=0.08). CONCLUSION: Treatment delay due to the COVID-19 pandemic cause progression of nAMD and visual impairment. To plan more frequent anti-VEGF treatments and visits may be an appropriate approach until the disease stabilizes. However, it should be kept in mind that despite the improvement in OCT findings, the desired success in VA could not be achieved in the short term.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , COVID-19/epidemiology , Macular Degeneration , Pandemics , Retinal Neovascularization , Time-to-Treatment , Aged , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , Delayed Diagnosis/statistics & numerical data , Disease Progression , Female , Humans , Intravitreal Injections , Macular Degeneration/diagnosis , Macular Degeneration/drug therapy , Macular Degeneration/epidemiology , Macular Degeneration/pathology , Male , Pandemics/statistics & numerical data , Physical Examination/statistics & numerical data , Prognosis , Retinal Neovascularization/diagnosis , Retinal Neovascularization/drug therapy , Retinal Neovascularization/epidemiology , Retinal Neovascularization/pathology , Retrospective Studies , SARS-CoV-2 , Time-to-Treatment/statistics & numerical data , Tomography, Optical Coherence , Treatment Outcome , Turkey/epidemiology , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Vascular Endothelial Growth Factor A/immunology
11.
Graefes Arch Clin Exp Ophthalmol ; 259(3): 567-574, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1060218

ABSTRACT

PURPOSE: Following the first wave of the COVID-19 pandemic in early 2020, the easing of strict measures to reduce its spread has led to a resurgence of cases in many countries at both the national and local level. This article addresses how guidance for ophthalmologists on managing patients with retinal disease receiving intravitreal injections of anti-vascular endothelial growth factor (VEGF) during the pandemic should be adapted to the local epidemic pressure, with more or less stringent measures implemented according to the ebb and flow of the pandemic. METHODS: The Vision Academy's membership of international retinal disease experts analyzed guidance for anti-VEGF intravitreal injections during the COVID-19 pandemic and graded the recommendations according to three levels of increasing epidemic pressure. The revised recommendations were discussed, refined, and voted on by the 14-member Vision Academy Steering Committee for consensus. RESULTS: Protocols to minimize the exposure of patients and healthcare staff to COVID-19, including use of personal protective equipment, physical distancing, and hygiene measures, should be routinely implemented and intensified according to local infection rates and pressure on the hospital/clinic or healthcare system. In areas with many COVID-19-positive clusters, additional measures including pre-screening of patients, postponement of non-urgent appointments, and simplification of complex intravitreal anti-VEGF regimens should be considered. Treatment prioritization for those at greatest risk of irreversible vision loss should be implemented in areas where COVID-19 cases are increasing exponentially and healthcare resources are strained. CONCLUSION: Consistency in monitoring of local infection rates and adjustment of clinical practice accordingly will be required as we move forward through the COVID-19 era. Ophthalmologists must continue to carefully weigh the risk-benefits to minimize the exposure of patients and healthcare staff to COVID-19, ensure that patients receive sight-saving treatment, and avoid the potential long-term impact of prolonged treatment postponement.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , COVID-19/epidemiology , SARS-CoV-2 , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Disease Transmission, Infectious/prevention & control , Humans , Intravitreal Injections , Personal Protective Equipment , Practice Guidelines as Topic , Retinal Diseases/drug therapy
13.
Ophthalmol Retina ; 5(10): 975-980, 2021 10.
Article in English | MEDLINE | ID: covidwho-1002942

ABSTRACT

PURPOSE: To examine the effect of delay in care on visual acuity (VA) in patients requiring intravitreal injections (IVIs). DESIGN: Retrospective cohort study. PARTICIPANTS: Patients 18 years of age or older with diabetic macular edema (DME), proliferative diabetic retinopathy (PDR), or both; neovascular age-related macular degeneration (nAMD); or retinal vein occlusion (RVO) scheduled to see a retina specialist during the mandated lockdown period (March 14 - May 4, 2020 [the coronavirus disease 2019 period]) and who had received an IVI in the 12 weeks prior. METHODS: Chart review was performed and demographics, diagnoses, procedures, and VA were recorded. MAIN OUTCOME MEASURES: VA in patients who completed, canceled, and no-showed for the scheduled visit. RESULTS: Of the 1041 total patients, 620 (60%) completed the scheduled visit, whereas 376 (36%) canceled and 45 (4%) no-showed. In patients who missed the visit, the average delay in care was 5.34 weeks. In those who missed a visit, VA was assessed at the subsequent visit. Patients who canceled a visit were older, and patients who no-showed had lower baseline vision (mean Early Treatment Diabetic Retinopathy Study letters ± standard error [SE]: no-show, 53.27 ± 3.21 letters; canceled, 60.79 ± 1.11 letters; and completed, 62.81 ± 0.84 letters; P = 0.0101) and were more likely to have DME, PDR, or both (no-show, 13 patients [29%]; canceled, 56 patients [16%]; completed, 81 patients [13%]; P = 0.0456). Patients who missed a visit lost vision as compared with the patients who completed one (no-show, -5.024 ± 1.88 letters; canceled, -1.633 ± 0.65 letters; completed, 0.373 ± 0.50 letters; P = 0.0028). Patients with DME, PDR, or both (-3.48 ± 1.95 letters vs. 2.71 ± 1.75 letters; P = 0.0203), with RVO (-3.22 ± 1.41 letters vs. 0.95 ± 1.23 letters; P = 0.0230), and, to lesser degree, with nAMD (-1.23 ± 0.70 letters vs. -0.24 ± 0.56 letters; P = 0.2679) lost vision compared with patients with same diagnoses who completed the scheduled visit. CONCLUSIONS: In patients requiring IVIs, a delay in care of 5.34 weeks resulted in vision loss. It was seen in all patients, but was more prominent in patients with DME, PDR or both and RVO. Further studies are necessary to examine whether these vision changes persist over a longer duration.


Subject(s)
COVID-19/epidemiology , Diabetic Retinopathy/drug therapy , Macular Edema/drug therapy , Ranibizumab/administration & dosage , SARS-CoV-2 , Time-to-Treatment/trends , Visual Acuity , Aged , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , Comorbidity , Diabetic Retinopathy/complications , Diabetic Retinopathy/epidemiology , Female , Follow-Up Studies , Humans , Intravitreal Injections , Macula Lutea/pathology , Macular Edema/epidemiology , Macular Edema/etiology , Male , Middle Aged , Ohio/epidemiology , Retrospective Studies , Time Factors , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors
16.
Graefes Arch Clin Exp Ophthalmol ; 258(12): 2621-2628, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-812593

ABSTRACT

PURPOSE: To estimate the impact of delayed care during the coronavirus disease 2019 (COVID-19) pandemic on the outcomes of patients with neovascular age-related macular degeneration (AMD). METHODS: Consecutive patients with diagnosis of neovascular AMD were consecutively enrolled between March 9, 2020, and June 12, 2020, (during and immediately after the Italian COVID-19 quarantine). During the inclusion (or pandemic) visit (V0), patients received a complete ophthalmologic evaluation, including optical coherence tomography (OCT). Best-corrected visual acuity (BCVA) and OCT findings from the two preceding visits (V-1 and V-2) were compared with data at V0. RESULTS: One-hundred patients (112 eyes) were enrolled in this study. The time interval between following visits was 110.7 ± 37.5 days within V0 and V-1 and 80.8 ± 39.7 days within V-1 and V-2, respectively (P < 0.0001). BCVA was statistically worse at the V0 visit as compared with the immediately preceding (V-1) visit (0.50 ± 0.43 LogMAR and 0.45 ± 0.38 LogMAR at the V0 and V-1 visits, respectively; P = 0.046). On structural OCT, 91 out of 112 (81.2%) neovascular AMD eyes displayed the evidence of exudative disease activity at the V0 visit, while 77 (68.7%) eyes exhibited signs of exudation at the V-1 visit (P = 0.022). No differences in terms of BCVA and OCT findings were detected between the V-1 and V-2 visits. In multiple regression analysis, the difference in BCVA between V0 and V-1 visits was significantly associated with the interval time within these two visits (P = 0.026). CONCLUSION: The COVID-19 pandemic-related postponement in patient care proved to be significantly associated with worse short-term outcomes in these patients.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , Betacoronavirus , Choroidal Neovascularization/drug therapy , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Retinal Neovascularization/drug therapy , Time-to-Treatment , Wet Macular Degeneration/drug therapy , Aged , Aged, 80 and over , Bevacizumab/therapeutic use , COVID-19 , Choroidal Neovascularization/diagnostic imaging , Choroidal Neovascularization/physiopathology , Female , Humans , Intravitreal Injections , Male , Middle Aged , Pandemics , Quarantine , Ranibizumab/therapeutic use , Receptors, Vascular Endothelial Growth Factor/therapeutic use , Recombinant Fusion Proteins/therapeutic use , Retinal Neovascularization/diagnostic imaging , Retinal Neovascularization/physiopathology , SARS-CoV-2 , Subretinal Fluid , Tomography, Optical Coherence , Treatment Outcome , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology , Wet Macular Degeneration/diagnostic imaging , Wet Macular Degeneration/physiopathology
17.
Indian J Ophthalmol ; 68(10): 2291-2293, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-796779

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a form of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has been declared a pandemic by the World Health Organization (WHO). Ocular manifestations related to COVID-19 are uncommon with conjunctivitis being reported in a few cases. We report a unique case of vasculitic retinal vein occlusion (RVO) secondary to COVID-19 in a 52-year-old patient who presented with the diminution of vision in the left eye 10 days after he tested positive for SARS-CoV-2. All investigations for vasculitis were negative. This case supports the mechanism of thrombo-inflammatory state secondary to the "cytokine-storm" as the pathogenesis for systemic manifestations of COVID-19.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/virology , Eye Infections, Viral/virology , Pneumonia, Viral/virology , Retinal Vasculitis/virology , Retinal Vein Occlusion/virology , Administration, Oral , Angiogenesis Inhibitors/therapeutic use , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Drug Therapy, Combination , Eye Infections, Viral/diagnosis , Eye Infections, Viral/drug therapy , Fluorescein Angiography , Glucocorticoids/therapeutic use , Humans , Intravitreal Injections , Male , Methylprednisolone/therapeutic use , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Ranibizumab/therapeutic use , Retinal Vasculitis/diagnosis , Retinal Vasculitis/drug therapy , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/drug therapy , SARS-CoV-2 , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors
18.
Graefes Arch Clin Exp Ophthalmol ; 258(12): 2655-2660, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-777820

ABSTRACT

PURPOSE: To quantify the shrinking in outpatient and intravitreal injections' volumes in a tertiary referral retina unit secondary to virus causing coronavirus disease 2019 (COVID-19). METHODS: In this retrospective cross-sectional study, we reviewed the charts of all patients who had a visit at a medical retina referral center during the Italian quarantine (from 9th of March 2020 to 3rd of May 2020). Number and characteristics of these data were compared with data from the same period in 2019 (from 9th of March 2019 to 3rd of May 2019). RESULTS: In the 2019 study period, there were 303 patients attending clinic (150 males, 153 females). In the 2020 study period, patients decreased to 75 (48 males, 27 females; P = 0.022 comparing gender prevalence between the two periods) with an overall reduction of 75.2%. Mean ± SD age was 71.4 ± 14.3 years (range 25-93 years) in the 2019 study period and 66.7 ± 13.1 years (range 32-91 years) in the 2020 study period (P = 0.005). The largest drop in outpatient volume was recorded in AMD patients (- 79.9%). Regarding the intravitreal treatments, there were 1252 injections in the 2019 period and 583 injections in the 2020 period (- 53.6% in injections). The drop in intravitreal treatments was larger in patients with posterior uveitis, retinal vein occlusion, and diabetes (- 85.7%, - 61.9%, and - 59.6%, respectively). CONCLUSION: The volume of outpatient visits and intravitreal injections declined during the COVID-19 quarantine. The short- and long-term impacts are that routine in-person visits and intravitreal injections are expected to increase after the quarantine and, even more, after the pandemic.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , Betacoronavirus , Coronavirus Infections/epidemiology , Office Visits/statistics & numerical data , Outpatients/statistics & numerical data , Pneumonia, Viral/epidemiology , Retinal Diseases/drug therapy , Adult , Aged , Aged, 80 and over , COVID-19 , Cross-Sectional Studies , Female , Humans , Intravitreal Injections , Italy/epidemiology , Male , Middle Aged , Pandemics , Quarantine , Referral and Consultation/statistics & numerical data , Retinal Diseases/diagnosis , Retinal Diseases/physiopathology , Retrospective Studies , SARS-CoV-2 , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology
19.
Clin Exp Ophthalmol ; 48(9): 1276-1285, 2020 12.
Article in English | MEDLINE | ID: covidwho-751780

ABSTRACT

BACKGROUND: Clinical ophthalmological guidelines encourage the assessment of potential benefits and harms when deciding whether to perform elective ophthalmology procedures during the COVID-19 pandemic, in order to minimize the risk of disease transmission. METHOD: We performed probability calculations to estimate COVID-19 infection status and likelihood of disease transmission among neovascular age-related macular degeneration patients and health-care workers during anti-VEGF procedures, at various community prevalence levels of COVID-19. We then applied the expected burden of COVID-19 illness and death expressed through health-adjusted life-years (HALYs) lost. We compared these results to the expected disease burden of severe visual impairment if sight protecting anti-VEGF injections were not performed. RESULTS: Our calculations suggest a wide range of contexts where the benefits of treatment to prevent progression to severe visual impairment or blindness are greater than the expected harms to the patient and immediate health care team due to COVID-19. For example, with appropriate protective equipment the benefits of treatment outweigh harms when the chance of progression to severe visual impairment is >0.044% for all scenarios where COVID-19 prevalence was 1/1000, even when the attack rate in the clinical setting is very high (5-43%). CONCLUSION: Unless COVID-19 prevalence is very high, the reduced disease burden from avoiding visual impairment outweighs the expected HALYs lost from COVID-19 transmission. This finding is driven by the fact that HALYs lost when someone suffers severe visual impairment for 5 years are equivalent to nearly 400 moderate cases of infectious disease lasting 2 weeks each.


Subject(s)
Angiogenesis Inhibitors/adverse effects , COVID-19/transmission , Disease Transmission, Infectious/statistics & numerical data , Macular Degeneration/drug therapy , Pandemics , SARS-CoV-2 , Visual Acuity , Aged , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , COVID-19/epidemiology , Comorbidity , Female , Humans , Intravitreal Injections/adverse effects , Macular Degeneration/epidemiology , Male , Middle Aged , Vascular Endothelial Growth Factor A/antagonists & inhibitors
20.
Am J Ophthalmol ; 222: 194-201, 2021 02.
Article in English | MEDLINE | ID: covidwho-739728

ABSTRACT

PURPOSE: To evaluate the effect of physician face mask use on rates and outcomes of postinjection endophthalmitis. DESIGN: Retrospective, comparative cohort study. METHODS: Setting: Single-center. StudyPopulation: Eyes receiving intravitreal anti-vascular endothelial growth factor injections from July 1, 2013, to September 1, 2019. INTERVENTION: Cases were divided into "Face Mask" group if face masks were worn by the physician during intravitreal injections or "No Talking" group if no face mask was worn but a no-talking policy was observed during intravitreal injections. MainOutcomeMeasures: Rate of endophthalmitis, visual acuity, and microbial spectrum. RESULTS: Of 483,622 intravitreal injections administered, 168 out of 453,460 (0.0371%) cases of endophthalmitis occurred in the No Talking group, and 9 out of 30,162 (0.0298%) cases occurred in the Face Mask group (odds ratio, 0.81; 95% confidence interval, 0.41-1.57; P = .527). Sixteen cases of oral flora-associated endophthalmitis were found in the No Talking group (1 in 28,341 injections), compared to none in the Face Mask group (P = .302). Mean logMAR visual acuity at presentation in cases that developed culture-positive endophthalmitis was significantly worse in the No Talking group compared to the Face Mask group (17.1 lines lost from baseline acuity vs 13.4 lines lost; P = .031), though no difference was observed at 6 months after treatment (P = .479). CONCLUSION: Physician face mask use did not influence the risk of postinjection endophthalmitis compared to a no-talking policy. However, no cases of oral flora-associated endophthalmitis occurred in the Face Mask group. Future studies are warranted to assess the role of face mask use to reduce endophthalmitis risk, particularly attributable to oral flora.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , Endophthalmitis/prevention & control , Eye Infections, Bacterial/prevention & control , Intravitreal Injections/adverse effects , Masks/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , Retinal Diseases/drug therapy , Endophthalmitis/etiology , Eye Infections, Bacterial/etiology , Humans , Physicians , Prognosis , Retrospective Studies , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity
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