Clinical Presentation of Rhegmatogenous Retinal Detachment during the COVID-19 Pandemic: A Historical Cohort Study

Abstract

Purpose: To investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic on the clinical presentation of acute, primary rhegmatogenous retinal detachment (RRD).

Design: Single-center, consecutive case series with historical controls.

Participants: Consecutive patients seeking treatment for primary RRD in a 50-day period during the COVID-19 pandemic (March 9-April 27, 2020) and the corresponding 50-day period during the previous year (March 4-April 22, 2019) in the United States.

Methods: The cohorts were compared to assess demographic variables and clinical presentations. Multivariate logistic regression was used to identify factors predictive of presenting macular attachment status.

Main outcome measures: The primary outcome was the proportion of patients with macula-on RRD at presentation. Secondary outcomes included visual acuity (VA), duration of symptoms before presentation, proportion seeking treatment within 1 day of symptom onset, and presence of primary proliferative vitreoretinopathy (PVR).

Results: Eighty-two patients were included in the 2020 cohort compared with 111 patients in the 2019 primary control cohort. Demographic factors were similar between the groups. Significantly fewer patients demonstrated macula-on RRD in the 2020 cohort (20/82 patients [24.4%]) than in the 2019 cohort (55/111 patients [49.5%]; P = 0.001). Patients in the 2020 cohort showed worse median VA at presentation (1.00 logarithm of the minimum angle of resolution [logMAR; Snellen equivalent, 20/200] in 2020 vs. 0.48 logMAR [Snellen equivalent, 20/60] in 2019; P = 0.008), fewer patients sought treatment within 1 day of symptoms (16/80 patients [19.5%] in 2020 vs. 41/106 patients [36.9%] in 2019; P = 0.005), and a greater proportion demonstrated primary PVR (11/82 patients [13.4%] in 2020 vs. 5/111 patients [4.5%] in 2019; P = 0.03). In multivariate analysis, younger age (P = 0.03) and established patient status (P = 0.02) were independent predictors of macula-on status in the 2020 cohort.

Conclusions: Patients with primary RRD during the 2020 COVID-19 pandemic were less likely to have macula-on disease and more likely to delay seeking treatment and to show worse vision and PVR.

Keywords: COVID-19; Retinal detachment.

Figure 1

Box-and-whisker plot illustrating distribution of presenting logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) in each cohort. The dark line depicts the median and the boxes depict the interquartile range. No significant difference was found in the distributions between the 2019 and 2018 control cohorts. Median VA in the 2020 cohort distribution was significantly worse than the 2019 cohort distribution (P = 0.008).

Figure 2

Bar graph showing proportion of patients with macula-on rhegmatogenous retinal detachment by (A) age and (B) established patient subgroups. No difference was found in the group younger than 50 years with respect to macula status between the cohorts, whereas fewer patients showed macula-on rhegmatogenous retinal detachment in the 2020 cohort (P < 0.001) compared with the 2019 control. For established patients, no significant difference was found with respect to macula status between the cohorts, whereas significantly fewer patients showed macula-on rhegmatogenous retinal detachment in 2020 among new patients (P = 0.001) compared with the 2019 control group.