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Review
. 2020 Jun;258(6):1149-1156.
doi: 10.1007/s00417-020-04703-x. Epub 2020 Apr 23.

Guidance for anti-VEGF intravitreal injections during the COVID-19 pandemic

Jean-François Korobelnik  1   2 , Anat Loewenstein  3 , Bora Eldem  4 , Antonia M Joussen  5 , Adrian Koh  6 , George N Lambrou  7 , Paolo Lanzetta  8   9   10 , Xiaoxin Li  11 , Monica Lövestam-Adrian  12 , Rafael Navarro  13 , Annabelle A Okada  14 , Ian Pearce  15 , Francisco J Rodríguez  16 , David T Wong  17 , Lihteh Wu  18
Affiliations
Review

Guidance for anti-VEGF intravitreal injections during the COVID-19 pandemic

Jean-François Korobelnik et al. Graefes Arch Clin Exp Ophthalmol. 2020 Jun.

Abstract

Purpose: There is an urgent need to address how to best provide ophthalmic care for patients with retinal disease receiving intravitreal injections with anti-vascular endothelial growth factor agents during the ongoing global COVID-19 pandemic. This article provides guidance for ophthalmologists on how to deliver the best possible care for patients while minimizing the risk of infection.

Methods: The Vision Academy's Steering Committee of international retinal disease experts convened to discuss key considerations for managing patients with retinal disease during the COVID-19 pandemic. After reviewing the existing literature on the issue, members put forward recommendations that were systematically refined and voted on to develop this guidance.

Results: The considerations focus on the implementation of steps to minimize the exposure of patients and healthcare staff to COVID-19. These include the use of personal protective equipment, adherence to scrupulous hygiene and disinfection protocols, pre-screening to identify symptomatic patients, and reducing the number of people in waiting rooms. Other important measures include triaging of patients to identify those at the greatest risk of irreversible vision loss and prioritization of treatment visits over monitoring visits where possible. In order to limit patient exposure, ophthalmologists should refrain from using treatment regimens that require frequent monitoring.

Conclusion: Management of patients with retinal disease receiving intravitreal injections during the COVID-19 pandemic will require adjustment to regular clinical practice to minimize the risk of exposure of patients and healthcare staff, and to prioritize those with the greatest medical need. The safety of patients and healthcare staff should be of paramount importance in all decision-making.

Keywords: COVID-19; Coronavirus; Ophthalmology; Recommendations; Retinal disease; Vision Academy.

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Conflict of interest statement

Jean-François Korobelnik is a consultant for Allergan, Bayer, Kanghong, Novartis, and Roche.

Anat Loewenstein is a consultant for Allergan, Bayer, Kanghong, Novartis, Roche, ForSight Labs, and Notal Vision.

Bora Eldem is a consultant for Bayer, Novartis, and Allergan.

Antonia M. Joussen has received research grants from Novartis and Bayer and is a consultant for Allergan, Bayer, Novartis, and Roche.

Adrian Koh is a consultant and advisor for Bayer, Novartis, Allergan, Carl Zeiss, Heidelberg, and Topcon.

George N. Lambrou is an employee of Bayer AG Pharmaceuticals.

Paolo Lanzetta is a consultant for Allergan, Bayer, CenterVue, Novartis, and Roche.

Xiaoxin Li is a consultant/advisor for Bayer and has received research funding from Bayer.

Monica Lövestam-Adrian has received research grants from Novartis and Bayer and is a consultant for Bayer, Novartis, Allergan, and Santen.

Rafael Navarro has received consultancy fees from Allergan and Bayer.

Annabelle A. Okada has received research grants from Alcon Pharma KK (Japan), Bayer Yakuhin Ltd. (Japan), Mitsubishi Tanabe Pharma Corporation (Japan), Novartis Pharma KK (Japan), and Santen Pharmaceutical Co. Ltd. (Japan); and personal fees from AbbVie Japan Inc., Alcon Pharma KK (Japan), Allergan Japan, Astellas Japan, Bayer Healthcare AG, Bayer Yakuhin Ltd. (Japan), Chugai Pharmaceutical Co. (Japan), Daiichi-Sankyo, Mitsubishi Tanabe Pharma Corporation (Japan), Novartis Pharma (Japan), Otsuka Pharmaceutical Co. Ltd. (Japan), Senju Pharmaceutical Co. Ltd. (Japan), and Santen Pharmaceutical Co. Ltd. (Japan).

Ian Pearce has received consultancy fees/travel/speaker fees from Allergan, Bayer, Novartis, and Roche.

Francisco J. Rodríguez is a consultant/member of the speaker bureau for Bayer, Novartis, and Allergan.

David T. Wong has received grants/research support from Bayer, Novartis, and Roche, and consulting fees from Alcon, Allergan, Bausch Health, Bayer, Novartis, Topcon, Zeiss, and has minor equity in Arctic DX.

Lihteh Wu is a consultant/member of the speaker bureau for Bayer and Quantel Medical.

Figures

Fig. 1
Fig. 1
Example of a slit lamp set-up equipped with a protective shield (image courtesy of Professor Anat Loewenstein)
See this image and copyright information in PMC

Comment in

References

    1. Lanzetta P, Loewenstein A, The Vision Academy Steering Committee Fundamental principles of an anti-VEGF treatment regimen: optimal application of intravitreal anti–vascular endothelial growth factor therapy of macular diseases. Graefes Arch Clin Exp Ophthalmol. 2017;255:1259–1273. doi: 10.1007/s00417-017-3647-4. - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention (2020) People who are at higher risk for severe illness. https://edubirdie.com/blog/people-at-increased-risk-for-severe-illness
    1. American Academy of Ophthalmology (2020) Important coronavirus updates for ophthalmologists. https://www.aao.org/headline/alert-important-coronavirus-context. Accessed March 31, 2020
    1. Société Française d'Ophtalmologie (2020) Quelle conduite à tenir adopter vis à vis des injections intravitréennes (IVT) dans cette période d’épidémie au Covid-19 - SARS-CoV-2 ? https://www.sfo.asso.fr/files/files/FPHUNG/epidemie_au_covid-19_-_ivt.pdf. Accessed March 31, 2020 - PMC - PubMed
    1. Deutsche Opthalmologische Gesellschaft (2020) Coronavirus COVID-19. https://www.dog.org/?cat=288. Accessed March 31, 2020

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