Impact of Lockdown During COVID-19 Outbreak on Ophthalmological Emergency in a Reference Center in France

Summary Purpose In March 2020, the sudden rise in the number of SARS-CoV-2 infections in France led the government to impose a strict lockdown during which all non-urgent medical consultations were postponed. From March 17 to May 10, 2020, private medical practices were closed, and telemedicine was encouraged. The consequences on ophthalmic care were dramatic, with over 90% of scheduled consultations canceled. The goal of this study was to describe consultations during the 2-month strict lockdown in Paris and to analyze its impact on the visual outcomes of patients consulting in the ophthalmology emergency department (OED). Methods Data of patients who presented to the OED of the A. de Rothschild Foundation Hospital (RFH), a tertiary ophthalmology center in Paris, France, during the lockdown period and its immediate aftermath were analyzed. The results were compared to the same time periods in the years 2018 and 2019. Four time periods were defined and numbered chronologically: March 17 to May 10, 2018 (period 1);March 17 to May 10, 2019 (period 2);March 17 to May 10, 2020 (period 3, the lockdown period);May 11 to June 9, 2020 (period 4, the post-lockdown period). Results The number of consultations was reduced by more than 50% during the lockdown period (n=2909 patients) and by 30% during the post-lockdown period (n=2622) when compared to periods 1 (n=7125) and 2 (n=8058). Even though LP4 saw an increase in the number of patients consulting, there was no increase in the rate of severe diseases (12.8% during LP3 vs. 11.1% during LP4), and the proportion of patients who were admitted was statistically similar (4.3% vs. 3.6%). Neuro-ophthalmic diseases were the most common during LP3 and LP4. Neovascular glaucoma was twice as common during post-LP4 (P=0.08). We noted a significant increase in patients with graft rejection consulting in our OED during the post-LP4 (P<0.001). These results were likely related to a delay in follow-up consultations due to the lockdown measures. Conclusion The reduction in the number of consultations in our OED during the lockdown period affected both minor emergencies and severe ophthalmic diseases, but with no significant delay in diagnosis. More longitudinal and longer study is needed to confirm this and to retrospectively analyze the effects of the COVID-19 outbreak and lockdown. Resume Introduction En mars 2020, l’augmentation brutale du nombre d’infections par le SARS-CoV-2, en France, a impose un confinement general strict ;ainsi, toutes les consultations non urgentes ont ete reportees entre le 17 mars 2020 et le 10 mai 2020. Plus de 90 % des consultations en ophtalmologie ont ete annulees. Le but de cette etude est d’evaluer l’impact de ce 1er confinement a Paris sur les urgences ophtalmologiques et de voir s’il y a eu des sequelles visuelles secondaires au report de consultation. Methodes Les donnees des patients, qui se sont presentes au service des urgences ophtalmologiques de la Fondation ophtalmologique Adolphe de Rothschild, Paris, France, ont ete enregistrees pendant le confinement et un mois apres. Tous les resultats ont ete compares a la meme periode en 2018 et en 2019. On definit ainsi 4 periodes : du 17 mars au 10 mai 2018 (P1) ;du 17 mars au 10 mai 2019 (p2) ;du 17 mars au 10 mai 2020 (LP3) ;du 11 mai au 9 juin 2020 (LP4). Resultats Le nombre des consultations aux urgences ophtalmologiques a diminue de 50 % durant le confinement (n=2909 LP3) et de 30 % au deconfinement (n=2622 LP4) compare a P1 (n=7125) et P2 (n=8085). Meme si durant le deconfinement LP4, on a eu une augmentation du nombre de consultants par jour, le pourcentage des pathologies severes n’a pas augmente (12,8 % LP vs 11,1 % LP4), ainsi que celui des hospitalisations (4,3 % vs 3,6 %). Les pathologies neuro-ophtalmologiques etaient les plus frequentes durant LP3 et LP4. Le glaucome neovasculaire etait 2 fois plus frequent durant LP4 (p=0,08). On a constate une augmentation significative des rejets de greffe de cornee durant LP4 (p<0,001) secondaire au retard de consultation durant le 1er confinement. Conclusion La chute brutale du nombre de patients consultant aux urgences ophtalmologiques durant le 1er confinement secondaire a l’epidemie COVID-19 a interesse aussi bien les pathologies benignes que severes, sans retard diagnostique significatif. Des etudes longitudinales et avec plus de recul sont necessaires pour analyser retrospectivement l’effet du confinement secondaire, l’epidemie COVD-19, sur les pathologies ophtalmologiques.