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Tertiary outpatient ophthalmology clinics are high-risk environments for COVID-19 transmission, especially retina clinics, where regular follow-up is needed for elderly patients with multiple comorbidities. Intravitreal injection therapy (IVT) for chronic macular diseases, is one of the most common procedures performed, associated with a significant burden of care because of the vigorous treatment regimen associated with multiple investigations. While minimizing the risk of COVID-19 infection transmission is a priority, this must be balanced against the continued provision of sight-saving ophthalmic care to patients at risk of permanent vision loss. This review aims to give evidence-based guidelines on managing IVT during the COVID-19 pandemic in common macular diseases such as age-related macular degeneration, diabetic macula edema and retinal vascular disease and to report on how the COVID-19 pandemic has affected IVT practices worldwide.To illustrate some real-world examples, 18 participants in the International Retina Collaborative, from 15 countries and across four continents, were surveyed regarding pre- and during- COVID-19 pandemic IVT practices in tertiary ophthalmic centers. The majority of centers reported a reduction in the number of appointments to reduce the risk of the spread of COVID-19 with varying changes to their IVT regimen to treat various macula diseases. Due to the constantly evolving nature of the COVID-19 pandemic, and the uncertainty about the normal resumption of health services, we suggest that new solutions for eye healthcare provision, like telemedicine, may be adopted in the future when we consider new long-term adaptations required to cope with the COVID-19 pandemic.
RESUMO
PurposeTo investigate the effect of preoperative steroid on anatomical and functional outcomes of vitrectomy in patients with rhegmatogenous retinal detachment with associated choroidal detachment (RRD-CD), a rare but particular type of RRD.Patients and methodsThis retrospective cohort study included RRD-CD patients at Siriraj Hospital during January 2005 to December 2014. Patients with preexisting uveitis or RRD with giant retinal tears were excluded. Preoperative, intraoperative, and postoperative data were reviewed and analyzed.ResultsA total of 76 patients (76 eyes) with RRD-CD were included: 37 patients without preoperative steroid (Group A) and 39 patients with preoperative steroid for a median of 7 days (Group B: 34 patients with oral prednisolone (0.5-1 mg/kg/day) and 5 patients with 20 or 40 mg of subtenon triamcinolone). The total retinal reattachment rate at 3 months after one operation was not different between the two groups (59 vs 51%) with adjustment for confounders. The proportion of patients with visual acuity (VA) improvement at 3 months was also not different (57 vs 54%). Survival analysis revealed that 96% of redetachment cases occurred within the first 3 months and redetachment rate was not different between the two groups for up to 3 years. However, Group B showed a significant regression (partial or complete) of CD prior to operation compared to Group A (82 vs 30%, P<0.001).ConclusionPreoperative steroid significantly improved CD before vitrectomy, but seemed not to improve the single-operation retinal reattachment rate or VA at 3 months when compared to no steroid treatment in RRD-CD patients.
