Intravitreal injections (IVI) of anti–vascular endothelial growth factor (anti–VEGF) agents have become the most prevalent intraocular procedure as they represent the major therapeutic modality for prevalent retinal conditions such as age-related macular degeneration (AMD) and diabetic retinopathy. Effective therapy requires adherence to a schedule of iterative IVI as well as routine clinic appointments. The ongoing coronavirus disease 2019 (COVID-19) pandemic has resulted in the reduction of attendance at scheduled clinic visits and IVI. In this study, we attempted to analyze the effect of COVID-19 on compliance with anti–VEGF therapy. A total of 636 eyes received injections during a 4-week period of the COVID-19 outbreak in the Retina Clinic. The number of clinic visits for IVI during 1 month from March 15 to April 14 of 2020 was compared to a similar time period in each of the last 4 years. The study demonstrates a decrease in clinic visits for IVI when compared with the same 4-week interval in the four previous years. Based on the trend of the previous 4 years, 10.2% of the year’s total was expected for this time period. Using this model, the 636 reported number of injections for the March–April 2020 period was ~ 5%. This represents a decrease of ~ 50% of the expected IVI for this time period. The COVID-19 outbreak in Israel severely impacted compliance with anti–VEGF treatments.
Importance It is well known that altitude ascent with intravitreal gas can cause expansion of gas and intraocular pressure (IOP) elevation. According to Boyle's law, the gas bubble will not expand unless a higher altitude than the gas insertion site has been reached. We report four cases in which intravitreal gas was injected at an altitude of 790 m (Jerusalem). All four cases developed high IOP even though they did not reach a higher altitude in their post-operative period. Observations A report of four patients following vitrectomy with 12% mixture of perfluoropropane and air are presented. All four patients arrived with ocular pain following the ascent by car of 765-1100 m to Jerusalem where the vitrectomy and gas insertion was conducted. Upon examination, all four patients had high IOP (30-55 mm Hg). IOP was well controlled with IOP-lowering medications. None of the patients suffered from long-term complications. Conclusions and Relevance Caution should be taken with altitude changes in patients with intravitreal gas even if there was no ascent from the altitude in which the vitrectomy was performed.
En face swept-source optical coherence tomography is a rapid, noninvasive, high-resolution, promising technology, which allows excellent visualization of retinal arterial macroaneurysms and their consequences on surrounding tissues. It could make angiography with intravenous injection redundant in planning and assessing therapy.
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