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Delayed Intravitreal Anti-VEGF Therapy for Patients During the COVID-19 Lockdown: An Ethical Endeavor

Authors Elfalah M, AlRyalat SA, Toro MD, Rejdak R, Zweifel S, Nazzal R, Abu-Ameerh M, Ababneh O, Gharaibeh A, Sharif Z, Meqbil J, AlShawabkeh M, Alwreikat A, Al Bdour M, Al-Hussaini M, Yousef YA

Received 4 November 2020

Accepted for publication 30 December 2020

Published 17 February 2021 Volume 2021:15 Pages 661—669


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Mutasem Elfalah,1 Saif Aldeen AlRyalat,1 Mario Damiano Toro,2– 4 Robert Rejdak,4 Sandrine Zweifel,3 Rashed Nazzal,5 Mohammed Abu-Ameerh,1 Osama Ababneh,1 Almutez Gharaibeh,1 Zuhair Sharif,1 Jehad Meqbil,1 Mo’ath AlShawabkeh,1 Amal Alwreikat,6 Muawyah Al Bdour,1 Maysa Al-Hussaini,7 Yacoub A Yousef8

1Department of Special Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan; 2Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland; 3Department of Ophthalmology, University Hospital of Zürich, Zürich, Switzerland; 4Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland; 5Shami Eye Center, Amman, Jordan; 6Department of Ophthalmology, Royal Medical Services, Amman, Jordan; 7Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan; 8Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan

Correspondence: Mutasem Elfalah
Department of Special Surgery, Faculty of Medicine, The University of Jordan, Queen Rania St, Amman, 11941, Jordan
Tel +96265355000
Mario Damiano Toro
Department of Ophthalmology, University Hospital of Zürich, Raemistrasse 100, Zürich, 8091, Switzerland
Tel +39 3495158220

Purpose: To assess the impact of Jordanian’s Corona Virus Disease (COVID-19) lockdown on visual acuity and macular thickness in patients with macular edema receiving intravitreal injections, and to assess the ethical endeavor of lockdown among serious sight threatening conditions.
Patients and Methods: This retrospective observational study included patients planned for intravitreal injections who did not complete the planned course before the lockdown (ie, before 20th of March 2020). Data included demographics, indication for the intravitreal injection, corrected distance visual acuity (CDVA), and central macular thickness on Optical Coherence Tomography (OCT) before and after the lockdown.
Results: One-hundred and sixty-six eyes of 125 patients were studied, 68 (54.4%) patients were males, and the mean (± standard deviation, SD) age was 64.79 (± 9.41) years. Mean (±SD) duration of delay in the planned injection was 60.97 (± 24.35) days. The change in visual acuity was statistically significant for patients with diabetic macular edema (p= 0.045 improvement), patients with central retinal vein thrombosis (CRVO) (p= 0.05 deterioration), and patients with age-related macular degeneration (AMD) (p= 0.005 deterioration). Of interest, delay of more than 2 months and the previous need for 3 or more injections were significant poor prognostic factors for visual outcome for patients with diabetic macular edema (p=0.027 and 0.045).
Conclusion: The impact of delay in the scheduled intravitreal injections resulted in variable outcomes depending on the indication. Triaging the urgency of patients should be based on the indication to support the equity principle of bioethics, where those in need are prioritized against others, depending on potential adverse outcome.

Keywords: COVID-19 lockdown, COVID-19 pandemic, ethics, intravitreal injection, macular edema

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