Cleveland Clinic Lerner College of Medicine at Case Western Reserve School of Medicine, Cleveland, Ohio.
Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Ophthalmol Retina. 2021 Oct;5(10):975-980. doi: 10.1016/j.oret.2020.12.020. Epub 2021 Jan 1.
To examine the effect of delay in care on visual acuity (VA) in patients requiring intravitreal injections (IVIs).
Retrospective cohort study.
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.
Chart review was performed and demographics, diagnoses, procedures, and VA were recorded.
VA in patients who completed, canceled, and no-showed for the scheduled visit.
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.
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.
研究需要玻璃体腔内注射（IVI）的患者延迟治疗对视力（VA）的影响。
回顾性队列研究。
18 岁或以上的糖尿病性黄斑水肿（DME）、增生性糖尿病视网膜病变（PDR）或两者兼有；新生血管性年龄相关性黄斑变性（nAMD）；或视网膜静脉阻塞（RVO）患者；安排在强制封锁期间（2020 年 3 月 14 日至 5 月 4 日[COVID-19 期间]）看视网膜专家，并在 12 周前接受 IVI。
进行图表审查，并记录人口统计学、诊断、程序和 VA。
完成、取消和未参加预约的患者的 VA。
在 1041 名患者中，620 名（60%）完成了预约，376 名（36%）取消了预约，45 名（4%）未参加预约。在错过预约的患者中，平均延迟治疗时间为 5.34 周。在错过预约的患者中，VA 在随后的就诊时进行了评估。取消预约的患者年龄较大，未参加预约的患者基线视力较低（平均早期治疗糖尿病性视网膜病变研究字母±标准误差[SE]：未参加，53.27±3.21 字母；取消，60.79±1.11 字母；和完成，62.81±0.84 字母；P=0.0101），且更有可能患有 DME、PDR 或两者兼有（未参加，13 例[29%]；取消，56 例[16%]；完成，81 例[13%]；P=0.0456）。与完成预约的患者相比，错过预约的患者视力下降（未参加，-5.024±1.88 字母；取消，-1.633±0.65 字母；完成，0.373±0.50 字母；P=0.0028）。患有 DME、PDR 或两者兼有（-3.48±1.95 字母与 2.71±1.75 字母；P=0.0203）、RVO（-3.22±1.41 字母与 0.95±1.23 字母；P=0.0230）、以及程度较轻的 nAMD（-1.23±0.70 字母与-0.24±0.56 字母；P=0.2679）与完成预约的同诊断患者相比，视力下降。
在需要 IVI 的患者中，5.34 周的治疗延迟导致视力丧失。所有患者都出现了这种情况，但在患有 DME、PDR 或两者兼有以及 RVO 的患者中更为明显。需要进一步研究以检查这些视力变化是否会持续更长时间。
