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Author Spotlight: A Novel Protocol for Intracameral Injections to Enhance Precision in Rodent Ophthalmology
Published on: May 31, 2024
Modifications of intravitreal injections in response to the COVID-19 pandemic
Chang-Chi Weng1, Ting-Yi Lin2,3, Yi-Ping Yang2,3
1Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Insights
During the COVID-19 pandemic, intravitreal injections (IVI) prioritization was necessary. Neovascular AMD and high-risk patients received top priority for IVI to prevent vision loss.
Area of Science:
- Ophthalmology
- Retina
- Public Health
Background:
- The COVID-19 pandemic significantly disrupted healthcare systems globally.
- Hospitals reduced non-urgent procedures and outpatient visits to manage pandemic impact.
- Lack of clear guidelines for urgent versus non-urgent intravitreal injections (IVI) created challenges.
Purpose of the Study:
- To summarize modifications in IVI algorithms during the COVID-19 crisis.
- To discuss patient prioritization for IVI based on medical urgency.
- To address management strategies in a resource-constrained environment.
Main Methods:
- Literature review of current practices and guidelines for IVI.
- Analysis of patient conditions requiring IVI and their associated risks.
- Assessment of evidence regarding treatment delays and visual outcomes.
Main Results:
- Neovascular age-related macular degeneration (nAMD) identified as the highest priority for IVI.
- High priority also given to monocular/quasi-monocular patients, neovascular glaucoma, and new patients with significant vision loss.
- Limited evidence for worse outcomes with delayed treatment in central retinal vein occlusion (CRVO) and proliferative diabetic retinopathy (PDR); regular follow-up recommended for diabetic macular edema (DME) and branch retinal vein occlusion (BRVO).
Conclusions:
- Modified IVI algorithms prioritized conditions with the highest risk of permanent vision loss.
- Management strategies aimed to reduce patient visits and IVI frequency while balancing risks of vision loss and COVID-19 infection.
- Regular monitoring is crucial for patients with DME and BRVO experiencing treatment delays.
Abstract:
The Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruption to the normal operation of the healthcare system. On a worldwide scale, hospitals suspended nonurgent surgeries and outpatient visits to downsize clinical loadings to redistribute manpower to counteract the pandemic's impact. So far, there is no evidence-based guideline defining a clear line between urgent and nonurgent indications of intravitreal injections (IVI). Herein, we aimed to summarize IVI algorithm modifications and discuss the patient prioritization according to medical needs in the hostile environment in the COVID crisis. Assessing current literature, we found that neovascular age-related macular degeneration is considered the utmost priority among conditions that require IVI. Other conditions assigned with a high priority include monocular or quasi-monocular patients (only one eye > 20/40), neovascular glaucoma, and new patients with significant vision loss. Although patients with central retinal vein occlusion and proliferative diabetic retinopathy are not advised to delay treatments, we found no consistent evidence that correlated with a worse outcome. Diabetic macular edema and branch retinal vein occlusion patients undertaking treatment delay should be regularly followed up every 2 to 3 months. Serving as the principle of management behind the algorithm modifications, the reduction of both patient visit and IVI therapy counts should be reckoned together with the risk of permanent visual loss and COVID infection.
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