Abstract
Purpose :
The COVID-19 pandemic has placed an unprecedented strain on the modern healthcare system with outpatient providers needing to make significant adjustments in practice patterns in response. Ophthalmologists face unique challenges with limited ability to practice remotely, need for close quarters contact to facilitate routine examination and lack of validated personal protection equipment compatible with standard ophthalmic examination equipment. Macular edema is one common retinal condition necessitating frequent examination and in-office intervention. In this single institution retrospective case series, visual outcomes were reviewed for patients with macular edema previously stabilized by regular intravitreal bevacizumab (IVA) injections that were extended as result of limitations imposed by the pandemic.
Methods :
Patients with stable macular edema from diabetic disease (DME) or retinal vein occlusion (RVO) were identified. A total of 11 patients (10 DME and 1 RVO, 11 eyes) underwent extended therapeutic interval. Patients were monitored using Snellen visual acuity, clinical examination and macular OCT.
Results :
The median injection frequency was increased from 42d (range 28-84d) to 84d (range 42-252d) with an average percentage increase in duration between injections of 45%. The number of treatment cycles under extended therapy was between 1-3 cycles. The length of extension was based on a combination of patient preference, logistical limitations and provider clinical judgment. Only one of eleven patients demonstrated recurrence of center-involving edema with extended injection interval. The visual decline in Snellen visual acuity for the affected patient was one line (20/40 to 20/50) without subjective appreciation of decreased vision. The remaining ten patients demonstrated no visual decline with extended therapy.
Conclusions :
These results suggest that temporary extension of IVA treatment interval leads to neither immediate nor significant visual decline in patients with previously well controlled edema. Long term follow-up is necessary to determine if these patients will remain clinically stable with extended therapy or if there is increased risk of recurrent or recalcitrant edema.
This is a 2021 ARVO Annual Meeting abstract.