Department of Ophthalmology, University of Texas Health San Antonio, San Antonio, TX, USA.
Korean J Ophthalmol. 2023 Aug;37(4):292-298. doi: 10.3341/kjo.2022.0147. Epub 2023 Jun 19.
This study aimed to investigate the impact of delayed retinal clinical care during the COVID-19 pandemic on the severity of proliferative diabetic retinopathy (PDR) and drivers of follow-up delay. We compared disease severity and follow-up rates of PDR patients requiring vitrectomy to those managed nonsurgically, and identified factors associated with need for vitrectomy.
The study included 739 patients diagnosed with PDR between January 1, 2018, and March 4, 2021, categorized into two groups based on outcome: vitrectomy nonvitrectomy. Statistical methods such as t-tests and chi-square tests were used to analyze differences in disease severity and follow-up rates before and after COVID-19 shutdown. A multivariate regression evaluated factors leading to vitrectomy by comparing initial ETDRS (Early Treatment of Diabetic Retinopathy Study) DR staging, disease stability, DR progression, proliferative complications, appointment intervals, follow-up variance, rescheduling rate, and no-show rate.
Of the 739 patients, 202 required vitrectomy, 537 were managed nonsurgically. The vitrectomy group had more severe or unstable disease before shutdown. The interval between patient visits preshutdown was 29.76 ± 45.11 days in the vitrectomy group and 40.23 ± 56.73 days in the nonvitrectomy group (p < 0.001). Both groups experienced a significant increase in appointment intervals after shutdown, with the vitrectomy group having a greater increase. Both groups had significantly increased rescheduling rate and minimally increased no-show rate. Patient-directed rescheduling was the main driver of appointment delays. Disease factors, such as tractional retinal detachment and higher ETDRS DR staging, increased the odds of vitrectomy, while appointment burden and follow-up variability had a minimal impact.
Patients with more severe PDR and greater delay in appointments due to the pandemic were more likely to require vitrectomy for proliferative complications. Patient-directed rescheduling was identified as the main driver of care delays, as opposed to clinic-directed rescheduling. This study highlights the importance of maintaining regular follow-up appointments for PDR patients during pandemics.
本研究旨在探讨 COVID-19 大流行期间延迟视网膜临床治疗对增殖性糖尿病视网膜病变（PDR）严重程度和随访延迟驱动因素的影响。我们比较了需要玻璃体切除术治疗和非手术治疗的 PDR 患者的疾病严重程度和随访率，并确定了与玻璃体切除术相关的因素。
本研究纳入了 2018 年 1 月 1 日至 2021 年 3 月 4 日期间诊断为 PDR 的 739 例患者，根据结局分为玻璃体切除术组和非玻璃体切除术组。采用 t 检验和卡方检验等统计方法分析 COVID-19 停诊前后疾病严重程度和随访率的差异。采用多元回归分析比较初始 ETDRS（糖尿病性视网膜病变早期治疗研究）DR 分期、疾病稳定性、DR 进展、增殖性并发症、就诊间隔、随访差异、重新安排率和失约率，以评估导致玻璃体切除术的因素。
739 例患者中，202 例需要玻璃体切除术，537 例接受非手术治疗。玻璃体切除术组在停诊前疾病更严重或更不稳定。停诊前患者就诊间隔为玻璃体切除术组 29.76 ± 45.11 天，非玻璃体切除术组 40.23 ± 56.73 天（p < 0.001）。两组停诊后就诊间隔均显著延长，玻璃体切除术组延长更明显。两组重新安排率均显著增加，失约率略有增加。患者自主重新安排是导致预约延迟的主要原因。牵引性视网膜脱离和更高的 ETDRS DR 分期等疾病因素增加了玻璃体切除术的可能性，而预约负担和随访变异性的影响较小。
在大流行期间，病情更严重且因疫情而预约延迟的 PDR 患者更有可能因增殖性并发症而需要玻璃体切除术。与诊所指导的重新安排相比，患者自主的重新安排被确定为护理延迟的主要驱动因素。本研究强调了在大流行期间维持 PDR 患者定期随访的重要性。
