Abstract
Purpose :
To examine the effect of the COVID-19 pandemic on the presentation and outcomes of county patients with complications of proliferative diabetic retinopathy (PDR) treated with pars plana vitrectomy (PPV).
Methods :
Chart review was conducted of all eyes of adult patients who underwent PPV for complications of PDR from March 20, 2018 – March 20, 2022 at two county hospitals. March 20, 2020 was used as the cut-off date to separate the pre- and post-COVID periods. Demographics, preoperative and postoperative characteristics were collected. All eyes were included for analysis of preoperative characteristics, while repeat PPVs and/or eyes that did not have six months of follow up were excluded from postoperative outcomes. Primary outcome was best-corrected visual acuity (BCVA) at postoperative month six (POM6).
Results :
During the pre-COVID period, 401 (38% of all PPVs) PPVs were performed for PDR, and 253 eyes had at least six months of follow up. During the post-COVID period, 347 (45%) PPVs were for PDR and 234 eyes had at least six months of follow up. There was no difference in demographics or preoperative BCVA on date of surgery request between the groups. Mean wait time from evaluation to surgery increased from 39 to 57 days (p=0.0004). More PPVs were done for tractional retinal detachment (TRD) [167 (48%) vs. 139 (35%); p=0.0009], and more eyes presented with mac-involving detachment post-COVID [91 (26%) vs. 77 (19%); p=0.0024] (Table 1). The mean BCVA at POM6 was worse post-COVID [logMAR (±SE); 1.11 (±0.05) vs 0.94 (±0.05); p=0.0132], and there were fewer patients who had 20/40 or better vision [34 (14%) vs 61 (24%); p=0.0098] (Table 2). Within six months, there were fewer incidences of vitreous hemorrhage [70 (20%) vs 103 (41%); p=0.0129] post-COVID, and no difference in incidences of elevated IOP or subsequent interventions for postoperative complications.
Conclusions :
During the post-COVID period, there were more cases of TRD and macula-involving detachment despite no difference in total PPV cases for PDR. This pattern – which likely contributes to the worse visual outcomes at six months despite lower rates of postoperative complications – persisted even two years after the shutdown and illustrates the lingering negative effects of pandemic-related interruptions in care on PDR severity and postoperative visual outcomes.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.