Ocular oncology practice guidelines during COVID-19 pandemic-An expert consensus

Impact of the SARS-CoV-2 (COVID-19) Pandemic on Characteristics and Management of Uveal Melanoma in the National Referral Center in Poland

(1) Background: to analyze the impact of the COVID-19 pandemic on the characteristics and management of uveal melanoma (UM) in the National Referral Center in Poland. (2) Materials and Methods: the retrospective analysis of 1336 patients who were newly diagnosed with UM at the Department of Ophthalmology and Ophthalmic Oncology, Jagiellonian University Collegium Medicum Krakow, Poland between 1 January 2018 and 31 December 2021. The demographic and clinical data were compiled, including localization, size, and treatment methods of tumors. (3) Results: In total, 728 patients with UM were included before the COVID-19 pandemic, in the years 2018-2019, and 608 were included during the COVID-19 pandemic, in the years 2020-2021. Fixed-base dynamics indicators for the incidence of uveal melanoma (base year 2018) in the National Referral Center in Poland were 80.22% and 86.81% in the years 2020 and 2021, respectively. UMs were statistically significantly larger and more frequently localized anterior to the equator of the eye globe in the year 2021 than in the year 2018 (Chi-square Pearson test p = 0.0001 and p = 0.0077, respectively). The rate of patients treated with enucleation increased from 15.94% in the year 2018 to 26.90% in the year 2021 (Chi-square Pearson test p = 0.0005). (4) Conclusions: Statistically significant differences were found in the management of uveal melanoma in the National Referral Center in Poland during the COVID-19 pandemic with tumors being larger, more frequently localized anterior to the equator of the eye globe, and more often enucleated.

Year 1 of COVID-19 pandemic in India: Effect of lockdown and unlock on the presentation of patients with ocular and periocular tumors at a referral center

PURPOSE

The purpose of the study is to describe the impact of lockdown and unlock phases of the COVID-19 pandemic on the presentation of ocular and periocular tumors at a referral center in India.

MATERIALS AND METHODS

This cross-sectional, hospital-based study included 5811 patients presenting between March 25, 2017, and March 31, 2021. The data on the patients diagnosed with ocular and periocular tumors in one or both eyes presenting during the lockdown and unlock phases were compared with the respective time periods in the previous 3 years before COVID-19.

RESULTS

The patient numbers dropped by 85% (45/295) of pre-COVID-19 volumes during the lockdown phase. This was mainly because of a 33% reduction in patients requiring inter-state travel. There was complete recovery of the outpatient numbers to 105% (139/132) of pre-COVID-19 volumes by March 2021. This gradual incremental trend was seen in patients with malignant tumors (145%) and was lower in those with benign tumors (89%) than pre-COVID-19 volumes by March 2021. There was an increase in the patients presenting with malignant tumors (49%; P = 0.45) during the lockdown phase. The proportion of patients requiring inter-state travel showed a near-complete recovery to 88% of pre-COVID-19 distribution by March 2021.

CONCLUSION

The 1^st year of the COVID-19 pandemic saw a significant decline in the number of patients presenting with ocular and periocular tumors. There was an increase in the proportion of malignant tumors and a decrease in benign tumors during the lockdown phase. During unlock period, there was a near-complete recovery in the patients requiring inter-state travel to access eye care services.

COVID-19 in Ophthalmology. Current Disease Status and Challenges during Clinical Practice

Purpose: The novel coronavirus disease 2019 (COVID-19) has raised a global public health concern. The purpose of this review is to summarize the evidence currently available on COVID-19 for its ocular implications and manifestations from both pathogenetic and clinical standpoints. Methods: For this narrative review, more than 100 relevant scientific articles were considered from various databases (PubMed, Google Scholar, and Science Direct) using keywords such as coronavirus outbreak, COVID-19, ophthalmology, ocular symptoms. Results:Daily healthcare both from patient and physician perspective, as well as on some guidelines regarding prevention and management have dramatically changed over the last few months. Although COVID-19 infection mainly affects the respiratory system as well as the gastrointestinal, cardiovascular, and urinary systems, it may cause a wide spectrum of ocular manifestations. Various challenges have to be faced to minimize exposure for both patients and physicians. Conclusion:The risk of COVID-19 infection should be considered and medical care should be prioritized for urgent cases. Appropriate management for patients with chronic cases that may result in adverse outcomes should not be neglected, while patients that can be monitored remotely should be identified.

Impact of COVID-19 nationwide lockdown on retinoblastoma treatment and outcome: A study of 476 eyes of 326 children

Purpose

The novel coronavirus SARS-CoV-2 (COVID-19) and the resultant nationwide lockdown and travel restrictions led to difficulty in providing timely and regular treatment to patients with childhood cancers such as retinoblastoma. This study is aimed at assessing the demography, clinical presentation, treatment strategies, and outcome of treatment defaulters due to the lockdown.

Methods

Cross-sectional, observational study of retinoblastoma patients at a tertiary care ocular oncology center during the first wave of COVID-19 and the resulting nationwide lockdown.

Results

Of the 476 eyes of 326 patients undergoing active management with a median age of 57 months (range: 4-214 months), 205 (63%) patients returned for follow-up after a mean delay of 45.8 ± 24.3 weeks (range: 8-80 weeks) and 121 (37%) were defaulters according to the data analyzed till June 30, 2021. Distance of residence was ≥1000 km for 148 patients (46%). In terms of need for active treatment, the number of emergent cases was 2 (<1%), 11 (3%) were urgent, and 313 (96%) were semi-urgent. International classification groups D (n = 107 eyes, 23%) and E (n = 173 eyes, 36%) were in majority, and 13 eyes (4%) and 4 eyes (1%) were at stages 3 and 4, respectively. Prior to lockdown, 86 eyes (18%) had active tumor, which remained unchanged (n = 26, 30%) or worsened (n = 49, 60%) after failure to follow-up. Vision (47%), eye (92%), and life salvage (98%) were achieved by individualized protocol-based management after the patients returned for further management. Five children succumbed to intracranial extension.

Conclusion

The COVID-19-related nationwide lockdown has deprived retinoblastoma patients of optimal and timely management, leading to prolonged treatment interruptions, delays, permanent default, and death. It is of paramount importance for all the stakeholders to increase awareness, make necessary travel and logistic arrangements, and ensure continuity of care for children with retinoblastoma.

Radiotherapy based management during Covid-19 pandemic - A systematic review of presented consensus and guidelines

Treatment management of cancer patients in the radiation oncology departments during the current COVID-19 pandemic is challenging. A systematic review of published consensus/guidelines on the role of radiotherapy prioritization, suggested treatment protocols, and set up management was undertaken based on the PRISMA protocol and through PubMed/PMC, Scopus, Google Scholar, Web of Science databases until 01/20/2021. One hundred and sixty-eight publications or regional consensus were included. Summary of recommendations contained: (1) using hypo-fractionated (Hypo-F) regimens for therapeutic/palliative indications, (2) delaying radiotherapy for several weeks or until pandemic over, (3) omitting radiotherapy by replacement of alternative therapies or active surveillance, (4) applying safer patients' setup and preparation protocols, (5) developing telemedicine/telehealth service. To conclude, it is essential to carefully weigh the risk of exposure to COVID-19 infection and the benefit of treating cancer patients during the pandemic. Trying to have a global guideline facing this or any other probable crisis is crucial for health care service.

Intricate scientometric analysis and citation trend of COVID-19-related publications in Indian Journal of Ophthalmology during COVID-19 pandemic

Purpose:

To analyze the trend of COVID-19-related publications in the Indian Journal of Ophthalmology (IJO) and assess the specialty wise correlation, distribution, and citation trend during the COVID-19 pandemic.

Methods:

A retrospective analysis of all COVID-19-related articles was performed from April 2020 to May 2021. The bibliographic records were obtained from the website of IJO, Editor IJO email, and PubMed. The data was then exported as XML into Microsoft access for scientometric analysis. The articles were segregated as Original, Review, Case Report/Series, Letter to the Editor/Commentary, Guest Editorial, PointCounterpoint, Consensus Criteria, Ophthalmic Images, Photo Essay, Surgical Techniques, and All India Ophthalmic Society Meeting Papers. The data was comprehensively analyzed for specialty-wise correlations, distribution, citation trend, and reasons for the same.

Results:

A total of 231 COVID-19-related articles were published during the study period. The maximum articles were [82 (35.49%)] letters to the editor, followed by [51 (22.08%)] original articles, [30 (12.99%)] commentaries, and [20 (8.66%)] editorials. The least were perspectives, consensus, images, and photo assay with [1 (0.43%)] each. The maximum publications were in July [44 (19.05%)] and least in April [1 (0.43%)]. Considering specialty, the maximum articles were related to general ophthalmology [124 (53.68%)] and least were in refractive surgery and community ophthalmology with [1 (0.43%)] each. The maximum citations were for original articles [352 (34.65%)], which was 2.3 times higher than review articles and letters to editor [150 (14.76%)]. General ophthalmology had 740 (72.83%) citations, which were nearly five times that of cornea [140 (13.78%)].

Conclusion:

The IJO showed a trough and crest pattern of COVID-19 publications month wise. Letter to editor and general ophthalmology COVID-19 articles had maximum publications with maximum citations for general ophthalmology owing to practice patterns and COVID-19 challenges.

Impact of COVID-19 pandemic on eye cancer care in United Kingdom

The COVID-19 pandemic has had an unprecedented impact on the National Health Service in United Kingdom. The UK Ocular Oncology Services evaluated the impact on the adult eye cancer care in the UK. All four adult Ocular Oncology centres participated in a multicentre retrospective review comparing uveal melanoma referral patterns and treatments in a 4-month period during the national lockdown and first wave of the COVID-19 pandemic in 2020 with corresponding periods in previous 2 years. During the national lockdown, referral numbers and confirmed uveal melanoma cases reduced considerably, equalling to ~120 fewer diagnosed uveal melanoma cases compared to previous 2 years. Contrary to the recent trend, increased caseloads of enucleation and stereotactic radiosurgery (p > 0.05), in comparison to fewer proton beam therapy (p < 0.05), were performed. In the 4-month period following lockdown, there was a surge in clinical activities with more advanced diseases (p < 0.05) presenting to the services. As the COVID-19 pandemic continues to mount pressure and reveal its hidden impact on the eye cancer care, it is imperative for the Ocular Oncology Services to plan recovery strategies and innovative ways of working.

The Management of Children with Cancer during the COVID-19 Pandemic: A Rapid Review

Despite the fact that cancer patients seem to be at a higher risk of being infected with SARS-CoV-2, limited data are available in the pediatric oncology setting. A systematic rapid review was conducted to analyze scientific literature regarding the management, interventions, and strategies adopted to prevent the spread of COVID-19 in the pediatric cancer population. Our search on PubMed, Scopus, Cochrane, and EMBASE databases yielded 505 articles. After removing duplicates, 21 articles were included. Articles focused on infection prevention (n = 19; 90.5%), management (n = 18; 85.7%), overall management of specific treatments for cancer (n = 13; 61.9%), and education (n = 7; 33.3%). The interventions adopted to prevent the spread of COVID-19 were similar across organizations and in line with general recommendations. Most of them reported interventions that could be used as valid strategies for similar emergencies. The strategies included limiting the risk of contagion by restricting access to the wards and implementing hygiene measures, the identification of separate pathways for the management of patients suspected or confirmed to be infected with COVID-19, the postponement of people accessing the hospital for non-urgent or unnecessary tests or medical examinations, and the preventive screening of patients before chemotherapy treatment or transplantation of hematopoietic stem cells. It is necessary to identify key indicators in order to better evaluate the effectiveness of the interventions implemented over time. A summary of the recommendations is provided.

Impact of COVID-19 pandemic, national lockdown, and unlocking on an apex tertiary care ophthalmic institute

PURPOSE

To evaluate the impact of 2019 COVID-19 pandemic, national lockdown, and unlocking on ophthalmic care provided by the government-funded apex health institute of India.

METHODS

Retrospective review of electronic medical records of all patients presenting to the ophthalmology department from March 23, 2020, to July 15, 2020, was compared with that from March 23, 2019, to July 15, 2019. The data between March 23, 2020, to May 31, 2020 (lockdown) and June 06, 2020, to July 15, 2020 (unlock) was compared separately. Parameters evaluated were age, gender, presenting complaints, final diagnosis, treatment advised, and surgical interventions.

RESULTS

During the lockdown, routine outpatient flow reduced by 97.14% (P < 0.001), the median age of presentation decreased to 29 years (55 years last year) and males increased by 4.7% (from 61.51% to 66.21%) in 2020. Emergency services decreased by 35.25%, percentage of children decreased by 4.28% (from 34.28% to 30%) and males increased by 13.53% (from 59.97% to 73.5%). Mechanical trauma, microbial keratitis, and conjunctivitis were the most common reasons for presentation. The former lessened by 41.75% while the latter two amplified by 1.25 times and 2 times, respectively. While sanitizer-associated chemical injury increased in proportion, endophthalmitis, and postoperative complications declined. The number of donor corneas collected and emergency therapeutic keratoplasties performed decreased by 99.61% and 92.39%, respectively (P < 0.001). During the unlocking phase, routine patient consultations were 71 ± 19/day, significantly lower than 978 ± 109/day of last year (P < 0.001). No voluntary eye donation was reported during this period.

CONCLUSION

COVID-19 pandemic and national lockdown severely hampered the delivery of ophthalmic care by the apex-ophthalmic institute. Unlike anticipated, lifting of pandemic-associated lockdown served only minimally in improving patient inflow in its initial phases.