The impact of 1stwave COVID-19 on macular diseases' management in a referral hospital in FRANCE

Purpose : To analyze the impact of the 1st wave COVID-19 on macular diseases' management in ophthalmology department of 'Centre hospitalier intercommunal de Creteil (CHIC)' and correlate it with patients' demographic and clinical features Methods : Retrospective cross-sectional study. During the lockdown period from March 17 to May 11th, 2020, we analyzed the activity in the medical retina and more specifically intra-vitreal injections (IVIs) and compared it to that of the same period in 2019. The impact of patients' demographic and clinical features (age, sex, visual acuity (VA), retinal disease, therapeutic strategy) on this activity was evaluated Results : In 2019, the number of IVIs carried out between March 17thand May 11th, combining all indications was 2189. In 2020, this number was 953 corresponding to a decrease of 56.46 %, statistically significant (p <0.05). During the 1 wave, 767 patients (1020 eyes) were scheduled for at least one IVI. 833 eyes of 615 patients received 1 or 2 scheduled IVIs (Group 1). 187 eyes of 152 patients did not receive any IVIs (Group 2). 83.06% out of the patients in group 1 received all the scheduled IVIs (1 or 2). 16.94% received only a single IVI when they were scheduled to receive a 2nd injection. In group 1, the average age is 76 y. Female patients represent 59.67%. Average VA before lockdown was 63.52 letters. This remained stable after, at 63.15 letters. The therapeutic strategy used before lockdown was Pro re nata (PRN) in 62.46% and Treat and extend (TAE) in 30.56%. Age related macular degeneration (AMD) was the most common disease (61.13%). In group 2, the average age is 76 y. Female patients represent 58.55%. Average VA before lockdown was 60.77 letters. It was reduced to 50.63 letters after. The predominant therapeutic strategy was PRN (47.05%) followed by TAE (32.62%). AMD was the most common disease (56.68%) Conclusions : The COVID-19 lockdown severely impacted management of macular diseases by IVIs at CHIC. The short-term impact on VA is significant in the absence of treatment. The impact is not statistically different with respect to age, gender, and retinal disease. However, regarding therapeutic strategy, PRN seems to have enabled a better observance. These results underline the importance of sensitizing patients to treatment observance. They can also contribute to develop effective management strategies for macular diseases during times of crisis.