Effect of delayed intravitreal injections on outcomes in patients with neovascular age-related macular degeneration during COVID-19

Abstract

Purpose: During the early stages of the COVID-19 pandemic, an intravitreal injection (IVI) decision-support tool was implemented at our site to reduce patient exposure to potentially high risk clinical settings. This tool provided recommendations, based on the patients general health risk and ocular health risk, with regard to postponing or extending IVI interval during this period. This study describes the outcomes of a cohort of patients managed with this tool. Methods: Single site, retrospective chart review of all patients receiving intravitreal anti-vascular endothelial growth factor agents for neovascular age-related macular degeneration who were managed using this decision making tool from 1 to 30 April 2020. Primary outcome of interest was change in logMAR visual acuity (VA) three months later. Secondary outcomes of interest were change central macular thickness (CMT) measured with optical coherence tomography, and the rate of serious complications such as submacular haemorrhage. Results: Thirty-three patients were included. Six had no change to their IVI interval, 14 had their interval extended and 13 had their IVIs paused for 3 months. LogMAR VA changed by a mean of +0.02 (standard deviation 0.15) and median of +0.1. CMT changed by a mean of +8.875 (standard deviation 55.20) and median of +8.5. No serious complications occurred. Conclusion: In patients with neovascular age-related macular degeneration, a treatment delay in those whose risk of COVID-19 morbidity and mortality was deemed to outweigh their ocular risk did not appear to cause visual compromise over a three month period. This decision making tool could be useful to guide management in future lockdowns.L6366695272021-12-27 <br />