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. 2020 Dec;258(12):2621-2628.
doi: 10.1007/s00417-020-04955-7. Epub 2020 Oct 3.

Short-term outcomes of patients with neovascular exudative AMD: the effect of COVID-19 pandemic

Enrico Borrelli  1 , Domenico Grosso  1 , Giovanna Vella  1   2 , Riccardo Sacconi  1 , Marco Battista  1 , Lea Querques  1 , Ilaria Zucchiatti  1 , Francesco Prascina  1 , Francesco Bandello  1 , Giuseppe Querques  3
Affiliations

Short-term outcomes of patients with neovascular exudative AMD: the effect of COVID-19 pandemic

Enrico Borrelli et al. Graefes Arch Clin Exp Ophthalmol. 2020 Dec.

Abstract

Purpose: To estimate the impact of delayed care during the coronavirus disease 2019 (COVID-19) pandemic on the outcomes of patients with neovascular age-related macular degeneration (AMD).

Methods: Consecutive patients with diagnosis of neovascular AMD were consecutively enrolled between March 9, 2020, and June 12, 2020, (during and immediately after the Italian COVID-19 quarantine). During the inclusion (or pandemic) visit (V0), patients received a complete ophthalmologic evaluation, including optical coherence tomography (OCT). Best-corrected visual acuity (BCVA) and OCT findings from the two preceding visits (V-1 and V-2) were compared with data at V0.

Results: One-hundred patients (112 eyes) were enrolled in this study. The time interval between following visits was 110.7 ± 37.5 days within V0 and V-1 and 80.8 ± 39.7 days within V-1 and V-2, respectively (P < 0.0001). BCVA was statistically worse at the V0 visit as compared with the immediately preceding (V-1) visit (0.50 ± 0.43 LogMAR and 0.45 ± 0.38 LogMAR at the V0 and V-1 visits, respectively; P = 0.046). On structural OCT, 91 out of 112 (81.2%) neovascular AMD eyes displayed the evidence of exudative disease activity at the V0 visit, while 77 (68.7%) eyes exhibited signs of exudation at the V-1 visit (P = 0.022). No differences in terms of BCVA and OCT findings were detected between the V-1 and V-2 visits. In multiple regression analysis, the difference in BCVA between V0 and V-1 visits was significantly associated with the interval time within these two visits (P = 0.026).

Conclusion: The COVID-19 pandemic-related postponement in patient care proved to be significantly associated with worse short-term outcomes in these patients.

Keywords: COVID-19; Neovascular AMD; Outcome; Retina.

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Conflict of interest statement

Francesco Bandello is a consultant for Alcon (Fort Worth, Texas, USA), Alimera Sciences (Alpharetta, Georgia, USA), Allergan Inc. (Irvine, California, USA), Farmila-Thea (Clermont-Ferrand, France), Bayer Shering-Pharma (Berlin, Germany), Bausch And Lomb (Rochester, New York, USA), Genentech (San Francisco, California, USA), Hoffmann-La-Roche (Basel, Switzerland), Novagali Pharma (Évry, France), Novartis (Basel, Switzerland), Sanofi-Aventis (Paris, France), Thrombogenics (Heverlee, Belgium), Zeiss (Dublin, USA). Giuseppe Querques is a consultant for Alimera Sciences (Alpharetta, Georgia, USA), Allergan Inc. (Irvine, California, USA), Amgen (Thousand Oaks, USA), Bayer Shering-Pharma (Berlin, Germany), Heidelberg (Germany), KBH (Chengdu; China), LEH Pharma (London, UK), Lumithera (Poulsbo; USA), Novartis (Basel, Switzerland), Sandoz (Berlin, Germany), Sifi (Catania, Italy), Sooft-Fidea (Abano, Italy), Zeiss (Dublin, USA). The other authors have no disclosures.

Figures

Fig. 1
Fig. 1
Graph showing the time interval between following visits. The COVID-19 pandemic caused a significant delay in the assessment of patients with neovascular AMD. The time interval between V0 (the inclusion visit during the COVID-19 pandemic) and the immediately preceding visit (V−1) was significantly longer than the interval between V−1 and the preceding visit (V−2). The inclusion visit was performed during the COVID-19 pandemic (from March 9, 2020, through June 12, 2020) and this period is highlighted in red in this graph
Fig. 2
Fig. 2
Bar chart showing differences in visual acuity between visits. Error-bar chart displaying study cohort’s visual acuity at different visits. The height of the bars corresponds to the mean value, while the error bars represent the standard deviation (SD) of the data. Best-corrected visual acuity (BCVA) was statistically worse at the inclusion (V0) visit as compared with the immediately preceding (V−1) visit. Conversely, no differences were detected in terms of BCVA between the V−1 and immediately preceding V−2 visits. Red asterisks indicate significative differences in the comparison with the previous visit
Fig. 3
Fig. 3
Bar chart showing differences in OCT findings between visits. Bar chart displaying study cohort’s structural OCT findings at different visits. The height of the bars corresponds to the number of eyes with the corresponding OCT finding graded. The number of patients with OCT sings of exudation and subretinal fluid at the inclusion (V0) visit was significantly higher as compared with the immediately preceding (V−1) visit. Conversely, no differences were detected in terms of OCT findings between the V−1 and V−2 visits. Red asterisks indicate significative differences in the comparison with the previous visit
Fig. 4
Fig. 4
Structural OCT from a patient with exudative neovascular AMD. Top panel, V−2 visit; middle panel, V−1 visit; bottom panel, V0 (inclusion) visit. The green arrows on the near-infrared reflectance images (left) shows the location and direction of the structural optical coherence tomography (OCT) B-scans (right images). At the V−2 and V−1 visits, the structural OCT B-scans show the presence of a fibrovascular pigment epithelial detachment associated with a small amount of subretinal hyperreflective material (SHRM). At the inclusion visit performed during the COVID-19 pandemic (V0), the structural OCT B-scan displays an increased quantity of SHRM with associated subretinal fluid. Similarly, the best-corrected visual acuity (BCVA) was significantly worse at the V0 visit, as compared with both the preceding visits (V−1 and V−2). The time interval between following visits was 63 (within V−1 and V−2) and 147 (within V0 and V−1) days
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