Intravitreal injections in the era of COVID-19-The Metro South Health Queensland experience

ABSTRACT

Background: Intravitreal anti-vascular endothelial growth factor therapy currently represents the treatment standard for vision-threatening macular conditions, while treatment delays cause precipitous vision loss. The COVID-19 pandemic prompted unprecedented delays for patients receiving intravitreal injections (IVI). We aim to provide real-world data on the effects of delayed IVI treatment due to COVID-19 at our center and its associated visual consequences. Method(s) In this retrospective cohort study based at a tertiary hospital in metropolitan Brisbane, medical records were reviewed for consecutive IVI patients within a 6-week interval between March-May 2020. Patients were divided into two groups based on whether they maintained or delayed their follow-up visit. Main outcome measures included best-corrected visual acuity (BCVA), central macular thickness as well as structural findings on OCT suggestive of disease activity. Result(s) A total of 682 patients were scheduled to receive IVI-based care, with treatment delay observed in 123 patients (18.5%) for an average period of 64 days. BCVA worsened in the delayed group by an average of 0.136 letters compared to 0.008 in the control group (p = 0.02), with the most significant change seen in neovascular age-related macular degeneration patients (p = 0.001). Patients on Aflibercept and Ranibizumab were more likely to maintain vision compared to those on Bevacizumab (p = 0.02 and p = 0.07). Retinal vein occlusion patients were most likely to suffer from longterm visual consequences from delayed follow-up. In multivariate linear regression model for risk factor analysis;BCVA, distance from hospital and patient age were all correlated with treatment delays. Conclusion(s) Patients who experienced treatment delays suffered short-term visual decline. However, visual losses were not sustained in majority of patients.