Ashkenazy Noy, Goduni Lediana, Smiddy William E
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
Clin Ophthalmol. 2021 Feb 3;15:413-417. doi: 10.2147/OPTH.S296345. eCollection 2021.
To determine secondary effects of the mandated COVID-19 pandemic closure period for elective treatment on non-elective, injection-based retina care and outcomes.
In this cross-sectional, retrospective analysis of a single-provider outpatient clinic across multiple satellites, consecutive patients returning for intravitreal injections (IVIs) of anti-vascular endothelial growth factor or corticosteroids were identified as "delayed" or "undelayed" during a six-week study interval during the COVID-19 pandemic that closely following a mandated period of prohibited elective encounters. A "delayed" encounter was defined as having a follow-up interval exceeding 33% of the recommended cycle. Patients seen for IVIs during the corresponding six-week interval a year previously were identified for study as pre-COVID-19 controls. Main outcome measures included best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) assessment based on findings of intraretinal or subretinal fluid consistent with new or recurrent neovascular events.
The study included 183 eyes of 144 patients who underwent IVI-based care from June 18, 2020, through August 7, 2020, compared to 193 eyes of 154 patients injected during the corresponding interval 1 year before. There were 62 eyes of 46 patients seen in the study period later than scheduled (among 144 patients of 183 eyes in total), which represented a larger proportion of delayed patients compared to the previous year (31.9% vs. 14.9%, p<0.0005). Considering the patterns from the control group, the attributed delay due to COVID-19 was 15.0% of patients. The delayed return eyes had a greater decline in BCVA (3 letters), higher rates of worsened OCT results (48%), and prompted reduction in previously prescribed injection intervals (p<0.02).
The unintended consequence of delayed care of patients on established care regimens should be anticipated, and mitigate strategies considered if similar restrictions are mandated in the future.
确定因新冠疫情强制关闭期而导致的选择性治疗延误对非选择性、基于注射的视网膜护理及治疗结果的继发性影响。
在对一家多卫星单提供者门诊诊所进行的横断面回顾性分析中，在新冠疫情期间一个为期六周的研究间隔内，将连续接受抗血管内皮生长因子或皮质类固醇玻璃体内注射（IVI）的患者确定为“延迟”或“未延迟”，该研究间隔紧跟强制禁止选择性诊疗的时期之后。“延迟”诊疗被定义为随访间隔超过推荐周期的33%。将前一年相应六周间隔内接受IVI治疗的患者确定为新冠疫情前的对照组进行研究。主要观察指标包括基于与新的或复发性新生血管事件一致的视网膜内或视网膜下液的检查结果的最佳矫正视力（BCVA）和光学相干断层扫描（OCT）评估。
该研究纳入了2020年6月18日至2020年8月7日期间接受基于IVI治疗的144例患者的183只眼，相比之下，前一年相应间隔内有154例患者接受注射的193只眼。在研究期间，有46例患者的62只眼就诊时间比预定时间晚（在总共183只眼中的144例患者中），与上一年相比，延迟患者的比例更高（31.9%对14.9%，p<0.0005）。考虑到对照组的模式，因新冠疫情导致的延迟就诊患者比例为15.0%。延迟复诊的眼睛BCVA下降更大（3行），OCT结果恶化的发生率更高（48%），并且促使之前规定的注射间隔缩短（p<0.02）。
应预料到对既定护理方案患者护理延迟所带来的意外后果，并且如果未来强制实施类似限制，应考虑缓解策略。
