The impact of the COVID-19 Pandemic on rhegmatogenous retinal detachment treatment patterns

COVID-19 reduced scleral buckling training in fellows and shifted young ophthalmologists' preference toward vitrectomy: An Asia-Pacific survey

BACKGROUND

To assess rhegmatogenous retinal detachment (RRD) surgery trends and training among young ophthalmologists (YOs, vitreoretinal fellows or attendings/consultants with ≤10 years of independent practice) and the impact of the COVID-19 pandemic.

METHODS

An anonymous online survey was completed by 117 YOs in the Asia-Pacific regarding their RRD surgery experiences in 2021-2022.

RESULTS

To achieve a 90% probability of surgical competency, 91 vitrectomy and 34 scleral buckling (SB) completions during fellowship were needed. In total, 49 (41.9%) YOs had fellowship affected by COVID-19. In the COVID versus pre-COVID era, however, the volume of SB completions per fellowship year decreased significantly (median [IQR] 3.3 [1.5, 9] vs. 13 [6.5, 23]; p < 0.001) and was lower than the required volume to achieve competency. YOs were less confident in conducting SB versus vitrectomy (3.5 ± 1.1 vs. 4.2 ± 0.8, p < 0.001), and they reported a decrease in the proportion of SB (-3.1%, p = 0.047) and an increase in the proportion of vitrectomy (+4.8%, p < 0.001) after the pandemic outbreak. Apart from RRD clinical characteristics, surgical confidence is among the main factors that affect surgical method decisions. During the pandemic, more YOs may have avoided SB due to the need for general anaesthesia, leading to longer surgical time and risk of viral transmission during intubation/extubation.

CONCLUSIONS

SB surgical exposure is suboptimal in most fellowship programs in the 11 Asia-Pacific countries/regions we surveyed and further declined during the COVID-19 pandemic. YOs are less confident in performing SB, leading to a trend toward primary vitrectomy since the COVID-19 outbreak.

Surgical decisions and outcomes of rhegmatogenous retinal detachment during the coronavirus disease 2019 pandemic: Data from a tertiary referral center in Taiwan

Purpose

To assess changes in surgical decisions and outcomes of rhegmatogenous retinal detachment (RRD) during the COVID-19 pandemic at a tertiary center in Taiwan.

Methods

Patients undergoing pars plana vitrectomy (PPV) or scleral buckling (SB) for primary RRD during Taiwan's first wave of domestic COVID-19 cases surge between May and July 2021 (COVID cohort, n = 100) were compared to controls in the closest pre-COVID year, 2019 (pre-COVID cohort, n = 121).

Results

The COVID cohort had significantly worse RRD presentation, received more PPV (alone or combined with SB (PPV + SB)) and less SB alone, and had comparable single-surgery anatomic success (SSAS) rates. In patients who underwent PPV, more underwent PPV + SB instead of PPV alone. The decision to combine SB in PPV surgery was significantly affected by the COVID pandemic (odds ratio [OR], 3.1860 [95% confidence interval (CI), 1.1487-8.8361]). However, a shorter duration of symptoms before the first presentation (0.9857 [95% CI, 0.9720-0.9997]) was the only factor related to SSAS, whereas the surgical method had no association. The SSAS rate remained close to or over 90% in patients with a duration of symptoms before surgery ≤4 weeks but dropped to 83.3% in patients with duration >4 weeks.

Conclusion

During the COVID-19 pandemic, worse RRD presentations led to a shift in preference for PPV over SB alone as the primary surgery. The pandemic affected surgeons' decision to combine SB during PPV. Nevertheless, SSAS was only associated with the duration of symptoms but not with surgical methods.

Impact of local COVID-19 alert levels on rhegmatogenous retinal detachment

PURPOSE

To investigate the impact of the local alert levels regarding coronavirus disease 2019 (COVID-19) on the clinical patterns of rhegmatogenous retinal detachment (RRD) in Japan.

STUDY DESIGN

Retrospective, single-center, consecutive case series.

METHODS

We compared two groups of RRD patients, a COVID-19 pandemic group and a control group. Based on the local alert levels in Nagano, five periods during the COVID-19 pandemic were further analyzed: epidemic 1 (state of emergency), inter-epidemic 1, epidemic 2 (second epidemic duration), inter-epidemic 2, and epidemic 3 (third epidemic duration). Patients' characteristics, including symptoms' duration before visiting our hospital, macula status, and retinal detachment (RD) recurrence rate in each period, were compared with those in a control group.

RESULTS

There were 78 patients in the pandemic group and 208 in the control group. The pandemic group had a longer duration of symptoms than the control group (12.0 ± 13.5 days vs. 8.9 ± 14.7 days, P = 0.0045). During the epidemic 1 period, patients had a higher rate of macula-off RRD (71.4% vs. 48.6%) and RD recurrence (28.6% vs. 4.8%) than the control group. This period also demonstrated the highest rates compared to all other periods in the pandemic group.

CONCLUSION

During the COVID-19 pandemic, RRD patients significantly delayed visiting a surgical facility. They showed a higher rate of macula-off and recurrence compared to the control group during the state of emergency than during other periods of the COVID-19 pandemic, although the difference was not statistically significant due to the small sample size.

Impact of COVID-19 Restrictions on Retinal Detachment: A Multicenter Experience

In this retrospective, multicenter study of 261 eyes (259 patients), patients who underwent rhegmatogenous retinal detachment repair during the coronavirus disease 2019 (COVID-19) post-lockdown period experienced an additional 22-day delay, leading to significantly more epiretinal membrane and proliferative vitreoretinopathy and lower single-surgery anatomic success rates. During lockdown, perfluoropropane gas was used more commonly, and pneumatic retinopexy was used more commonly in COVID-19–positive patients.