Incidence and characteristics of rhegmatogenous retinal detachment during coronavirus-19 pandemic: A French study

Purpose

To assess the impact of the Covid-19 pandemic and subsequent lockdown on the number and clinical characteristics of patients with retinal detachment (RD) in a French public university eye hospital.

Methods

Single-center, retrospective non-interventional study. Patients consulting at the emergency room (ER) of Quinze-Vingts Hospital (France) for rhegmatogenous RD before and after instauration of the lockdown were reviewed. We compared the characteristics of patients with RD between the containment period (March17th - April27th,2020) and the period preceding the lockdown (February18th - March16th,2020). We compared the number of RD surgeries performed between the first month of lockdown (March17th - April19th,2020) and the corresponding period of 2019. Number of cases, delay between diagnosis and surgery, visual acuity was measured.

Results

During the first month of lockdown, 59 RDs were operated on, compared to 107 in the corresponding period in 2019 (-44,8%). Mean time from first symptoms to surgery was significantly higher during the lockdown 12.7 (11.3) days vs 7.6 (7.8) days (p = 0.031) before. During the lockdown, the mean BCVA was lower albeit the difference did not reach statistical significance (1.16 (0.9) during pre-containment vs 1.5 (0.9) during containment; p = 0.09). Reasonsfor delayed consultation were: fear of Covid-19 (31%; p = 0.0001), absence of referral doctor (31%; p = 0.003) and difficulties in getting to public transport (10.3%;p = 0.859).

Conclusion

Despite maintaining accessto emergency eye care facilitiesin our hospital, the lockdown affected visual health. Should the lockdown be reinstated, we postulate that a better information about eye care access for non-Covid emergencies may attenuate its effect on visual health.

Comparative Biochemical Outcomes, Effectiveness and Tolerance of Densiron 68 and Oxane HD for the Management of Complicated Retinal Detachment

Objectives:

To compare biochemical outcomes, effectiveness, and tolerance of two high-density silicone oils (HDSOs), silicone oil- RMN3 (Oxane^® HD) and silicone oil-Densiron-68 (Densiron^® 68), for the management of complicated retinal detachment (RD) associated with inferior proliferative vitreoretinopathy (PVR).

Materials and Methods:

This was a retrospective, single-centre, comparative case series of 23 patients treated between September 2014 and June 2016. The main inclusion criteria were RD with inferior PVR receiving Oxane^® HD or Densiron^® 68 following pars plana vitrectomy. The main outcome measures were anatomical success, rate of RD recurrence, and best-corrected visual acuity (BCVA) at 6 months. Secondary outcomes were short-term complications.

Results:

Twenty-three eyes were included: 16 eyes with Densiron^® 68 tamponade and 7 eyes with Oxane^® HD tamponade. Anatomical success under HDSO was significantly higher in the Densiron^® 68 group (100%) than in the Oxane^® HD group (42.8%) (p=0.0455). Recurrent RD was observed in 42.8% of eyes under Oxane^® HD, but in none of the patients under Densiron^® 68 (p=0.001). Six months after surgery, mean BVCA values (+/- standard deviation) with Densiron^® 68 and Oxane^® HD were 0.83±0.62 logMAR and 1.81±0.65 logMAR, respectively. BVCA was significantly better in the Densiron^® 68 group (p=0.006). No significant differences were observed with regard to intraocular pressure, emulsification, or intraocular inflammation.

Conclusion:

Densiron^® 68 appears to be more effective than Oxane^® HD for the management of RD associated with PVR. A randomized, controlled, interventional study is needed to demonstrate this difference.

Trends in initiation of direct oral anticoagulant therapies for atrial fibrillation in a national population-based cross-sectional study in the French health insurance databases

OBJECTIVE

Unlike several other national health agencies, French health authorities recommended that the newer direct oral anticoagulant (DOAC) agents only be prescribed as second choice for the treatment of newly diagnosed non-valvular atrial fibrillation (NVAF), with vitamin K antagonists (VKA) remaining the first choice. We investigated the patterns of use of DOACs versus VKA in the treatment of NVAF in France over the first 5 years of DOAC availability. We also identified the changes in patient characteristics of those who initiated DOAC treatment over this time period.

METHODS

Based on the French National Health Administrative Database, we constituted a population-based cohort of all patients who were newly treated for NVAF between January 2011 and December 2015. Trends in drug use were described as the percentage of patients initiating each drug at the time of treatment initiation. A multivariate analysis using logistic regression model was performed to identify independent sociodemographic and clinical predictors of initial anticoagulant choice.

RESULTS

The cohort comprised 814 446 patients who had received a new anticoagulant treatment for NVAF. The proportion of patients using DOACs as initial anticoagulant therapy reached 54% 3 months after the Health Ministry approved the reimbursement of dabigatran for NVAF, and 61% by the end of 2015, versus VKA use. In the multivariate analysis, we found that DOAC initiators were younger and healthier overall than VKA initiators, and this tendency was reinforced over the 2011-2014 period. DOACs were more frequently prescribed by cardiologists in 2012 and after (adjusted OR in 2012: 2.47; 95% CI 2.40 to 2.54).

CONCLUSION

Despite recommendations from health authorities, DOACs have been rapidly and massively adopted as initial therapy for NVAF in France. Observational studies should account for the fact that patients selected to initiate DOAC treatment are healthier overall, as failure to do so may bias the risk-benefit assessment of DOACs.