Back to basics: measuring the impact of interventions to limit the spread of COVID-19 in Europe.

BACKGROUND: Following the emergence of the COVID-19 pandemic in Europe at the start of 2020, most countries had implemented various measures in an attempt to control the spread of the virus. This study analyses the main non-pharmaceutical interventions and their impact on the rate by which cumulative cases and deaths were growing in Europe during the first wave of this pandemic. METHODS: The interventions analysed are the school closures, restrictions on travel, cancellation of events, restrictions on gatherings, partial and full lockdowns. Data was collected on the implementation date of these interventions, and the number of daily cases and deaths during the first wave of the pandemic for every country and territory geographically located in Europe. The study uses growth rates to calculate the increase in cumulative cases and deaths in Europe before, during, and after these interventions were implemented. RESULTS: The results show that decisions to close schools, cancel events, and restrict travel were taken during the same time period, whereas the decisions for the other interventions were taken when the growth rates were similar. The most effective interventions at lowering the rate by which cumulative cases were increasing were the travel restrictions, school closures, and the partial lockdown, while most effective against cumulative deaths were the partial lockdown, travel restrictions, and full lockdown. CONCLUSION: All the interventions reduced the rate by which cumulative cases and deaths were increasing with the partial lockdowns being the most effective from the other interventions, during the first wave of the pandemic in Europe.

On Determining the Age Distribution of COVID-19 Pandemic.

Pandemics tend to have higher occurrence (morbidity) in younger individuals but higher mortality for the elderly. The higher rate of mortality of COVID-19 in elderly individuals has been discussed in many reports. However, this pandemic is a double-edged sword as this comment shows higher morbidity rates in elderly as well. This is shown by comparing the age distribution of cases in China and South Korea to the relative populations. In every case, the relative number of elderly contracting the virus is far higher than the proportion of elderly in the population. This is unlike past pandemics and shows that aging populations are at an even higher risk than the perceived age dependent rates may imply.

Real-world treatment of diabetic macular oedema: a comparison of combined ranibizumab plus macular LASER with macular LASER monotherapy.

OBJECTIVE: To study real world outcomes of ranibizumab (Lucentis) intravitreal injection in diabetic macular oedema (DMO). SUBJECTS AND METHODS: We included 100 patients with DMO. Those who had optical coherence tomography central retinal thickness (CRT) of 400µm or more (Group 1) underwent combination treatment with ranibizumab and macular LASER, while those with CRT less than 400µm (Group 2) had LASER monotherapy. The primary outcome measure was change in best corrected visual acuity (BCVA) from baseline. Secondary outcomes were change of CRT from baseline, the number of intravitreal injections in group one during the first and second year of follow-up and the proportion of LASER sessions in both groups at 2 years follow-up. Patients' lipid profile was compared to the presence and extent of macular hard exudates, quantified using masked readers and image analysis software. RESULTS: Group 1 showed better outcomes in terms of BCVA and CRT compared to Group 2 during the two-year follow-up period. The mean number of ranibizumab intravitreal injections in Group 1 was reduced from 3.86 (standard deviation±1.37) in the first year to 2.02 in the second year. At 2 years, Group 1 had a higher proportion of individuals that had undergone 3 macular LASER treatments (4% Group 1, 28% Group 2). The presence of hard exudates was associated with higher total cholesterol (P=0.004 and P=0.041 group 1 and 2 respectively) and with higher low density lipoprotein (LDL) cholesterol (P=0.01 and P=0.045 respectively). The size of hard exudates was associated with higher total cholesterol (P=0.02 and P=0.03 respectively) and with higher LDL cholesterol (P=0.003 and P=0.01 respectively). Neither high density lipoprotein (HDL) cholesterol, nor triglycerides were related to the presence or size of hard exudates. No serious adverse events were attributed to either LASER or ranibizumab. CONCLUSIONS: Combination treatment of intravitreal ranibizumab injections and macular LASER appears safe and effective over two years. The need for injection declines over time. There is an association between higher levels of serum total and LDL cholesterol and the presence and the extent of hard exudates.

Intravitreal aflibercept (A-IVI) for the treatment of neovascular age-related macular degeneration (nv-AMD): one year experience.

OBJECTIVE: To report the anatomical and functional results of intravitreal injections of aflibercept (Eylea) (A-IVI) for the treatment of naïve eyes with neovascular age-related macular degeneration (nv-AMD). SUBJECTS AND METHODS: This retrospective, one-center, non-comparative chart review included 26 treatment naïve eyes with nv-AMD of 26 patients (14 male) with a mean age of 80.5 (range 63-91) who had a complete follow-up of 14 months. The morphological analysis included spectral domain optical coherence tomography and fundus fluorescein angiography, while the functional assessment included logarithm of the minimum angle of resolution (LogMAR) best correct visual acuity (BCVA). The timing of the follow-up was: baseline, 3, 6, and 14 months. All patients received 8 A-IVI according to the protocol (first 3 consecutive monthly A-IVI, followed by bi-monthly retreatment for the first year, regardless of disease activity as per local guidelines). Statistical analysis was performed using ANOVA. Improvement of visual acuity more than 15 letters was considered as "improvement", less than 5 letters as "stable" and any letter loss as "worsening". RESULTS: Mean±standard deviation LogMAR visual acuity improved from 0.26±0.15 at presentation to 0.14±0.20 at the final follow-up of 14 months (P=0.02). BCVA was stable in 23.1%, improved in 61.5% (16 eyes) worsened in 15.4%. A mean pretreatment central macular thickness of 409µm reduced significantly to 229µm at month 14 (P<0.02). The OCT of eyes with worsened BCVA showed resolution of retinal fluid but presence of subretinal fibrosis. No adverse events were attributed to aflibercept. CONCLUSIONS: Patients who had a worsening in visual acuity were found to have longer duration of symptoms prior to treatment and presence of geographic atrophy, and/or subretinal haemorrhage and/or subretinal fibrosis at baseline. From our experience, with 14 months follow-up, A-IVI is an effective treatment for treatment naïve patients with nv-AMD. Our real world results were similar to pivotal trials.

Phacoemulsification surgery in eyes with neovascular age-related macular degeneration.

Purpose. To evaluate the visual outcomes and effect of phacoemulsification surgery on the progression of neovascular age-related macular degeneration (AMD). Methods. Retrospective, noncomparative, and interventional case series. Thirty eyes from 29 subjects with neovascular AMD treated with intravitreal antivascular endothelial growth factor (VEGF) injections who underwent phacoemulsification and had a postsurgery follow-up of 6 months were included. LogMAR best corrected visual acuity (BCVA) was assessed preoperatively; 1 month, 3 months, and 6 months postoperatively; and finally at the last visit. The frequency of anti-VEGF therapy, calculated as the number of intravitreal injections per month, and central macular thickness (CMT) before and after cataract surgery were determined. Results. Median (range) logMAR BCVA was 0.69 (0.16 to 1.32) preoperatively; 0.55 (-0.04 to 1.32) at 1 month, 0.52 (-0.1 to 1.32) at 3 months, and 0.50 (0.0 to 1.32) at 6 months postoperatively; and 0.6 (0.0 to 1.4) at final visit (P = 0.0011). There was no difference in the frequency of anti-VEGF injections between the immediate 6 months before and after phacoemulsification, which was equal to 0.1667 injections per month (P = 0.6377). Median CMT measured 203 µ m preoperatively, which temporarily increased to 238 µ m at 1 month after surgery (P = 0.0093) and then spontaneously returned to baseline, measuring 212.5 µ m at 3 months postoperatively (P = 0.3811). Conclusion. Phacoemulsification surgery significantly improved vision in patients with neovascular AMD, with no increased need for anti-VEGF injections to keep the macula dry postoperatively.