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. 2021 Feb 17:15:661-669.
doi: 10.2147/OPTH.S289068. eCollection 2021.

Delayed Intravitreal Anti-VEGF Therapy for Patients During the COVID-19 Lockdown: An Ethical Endeavor

Mutasem Elfalah  1 , Saif Aldeen AlRyalat  1 , Mario Damiano Toro  2   3   4 , Robert Rejdak  4 , Sandrine Zweifel  3 , Rashed Nazzal  5 , Mohammed Abu-Ameerh  1 , Osama Ababneh  1 , Almutez Gharaibeh  1 , Zuhair Sharif  1 , Jehad Meqbil  1 , Mo'ath AlShawabkeh  1 , Amal Alwreikat  6 , Muawyah Al Bdour  1 , Maysa Al-Hussaini  7 , Yacoub A Yousef  8
Affiliations

Delayed Intravitreal Anti-VEGF Therapy for Patients During the COVID-19 Lockdown: An Ethical Endeavor

Mutasem Elfalah et al. Clin Ophthalmol. .

Abstract

Purpose: To assess the impact of Jordanian's Corona Virus Disease (COVID-19) lockdown on visual acuity and macular thickness in patients with macular edema receiving intravitreal injections, and to assess the ethical endeavor of lockdown among serious sight threatening conditions.

Patients and methods: This retrospective observational study included patients planned for intravitreal injections who did not complete the planned course before the lockdown (ie, before 20th of March 2020). Data included demographics, indication for the intravitreal injection, corrected distance visual acuity (CDVA), and central macular thickness on Optical Coherence Tomography (OCT) before and after the lockdown.

Results: One-hundred and sixty-six eyes of 125 patients were studied, 68 (54.4%) patients were males, and the mean (± standard deviation, SD) age was 64.79 (±9.41) years. Mean (±SD) duration of delay in the planned injection was 60.97 (±24.35) days. The change in visual acuity was statistically significant for patients with diabetic macular edema (p= 0.045 improvement), patients with central retinal vein thrombosis (CRVO) (p= 0.05 deterioration), and patients with age-related macular degeneration (AMD) (p= 0.005 deterioration). Of interest, delay of more than 2 months and the previous need for 3 or more injections were significant poor prognostic factors for visual outcome for patients with diabetic macular edema (p=0.027 and 0.045).

Conclusion: The impact of delay in the scheduled intravitreal injections resulted in variable outcomes depending on the indication. Triaging the urgency of patients should be based on the indication to support the equity principle of bioethics, where those in need are prioritized against others, depending on potential adverse outcome.

Keywords: COVID-19 lockdown; COVID-19 pandemic; ethics; intravitreal injection; macular edema.

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Conflict of interest statement

Dr Sandrine Zweifel reports grants, personal fees from Bayer Healthcare Pharmaceuticals, grants, personal fees from Novartis Pharma AG, and personal fees from Roche Diagnostics, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
A framework for prioritizing patients receiving intravitreal injections based on their indications.
See this image and copyright information in PMC

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References

    1. WHO Director-General’s opening remarks at the media briefing on COVID-19-11 March 2020 [Internet]. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-re.... Accessed June19, 2020
    1. Pei X, Jiao X, Lu D, Qi D, Huang S. How to face COVID-19 in ophthalmology practice medical hypothesis, discovery & innovation in ophthalmology. Available from: http://mehdijournal.com/index.php/mehdiophthalmol/article/view/830. Accessed January29, 2021.
    1. Hu VH, Watts E, Burton M, et al. Protecting yourself and your patients from COVID-19 in eye care. Community Eye Health. 2020;33(108):S1–6. - PMC - PubMed
    1. Tognetto D, Brézin AP, Cummings AB, et al. Rethinking elective cataract surgery diagnostics, assessments, and tools after the COVID-19 pandemic experience and beyond: insights from the EUROCOVCAT GROUP. DIAGNOSTICS (Basel). Diagnostics. 2020;10(12):E1035. doi:10.3390/diagnostics10121035 - DOI - PMC - PubMed
    1. Ferrara M, Romano V, Steel DH, et al. Reshaping ophthalmology training after COVID-19 pandemic. Eye. 2020;1:1–9. - PMC - PubMed

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