Effect of Lockdown and Unlock Following COVID-19 on the Presentation of Patients With Endophthalmitis at a Tertiary Eye Center Over One Year

Abstract

Introduction Endophthalmitis is an emergency where patients need immediate intervention to salvage both vision and the globe. Regular follow-up care and close monitoring of the status of the patient are crucial in determining the final outcomes of the treatment. While there is ample literature on the epidemiology and demography of endophthalmitis across the globe, no information exists on the effect of the coronavirus disease 2019 (COVID-19) pandemic on the presentation patterns of endophthalmitis. Objectives To describe the impact of the lockdown and unlock phases of the COVID-19 pandemic on the presentation of endophthalmitis at a tertiary eye care center in India. Methods This cross-sectional hospital-based study included 1,253 patients presenting between March 25, 2017, and March 31, 2021. The data on the patients diagnosed with endophthalmitis in one or both eyes presenting during the lockdown and unlock phases were compared with the respective time periods in the previous three years before COVID-19. Results The patient numbers dropped to 42.18% (27/64) of pre-COVID-19 volumes during the lockdown phase. There was a near-complete recovery of the outpatient numbers to 85.71% (26/30) of pre-COVID-19 volumes by March 2021. This gradual incremental trend was seen in etiology due to post-surgery (88%) and endogenous (159%) infections while post-traumatic (67%) and post-infection (0%) infections were lower than pre-COVID-19 volumes by March 2021. There was a slight increase in the proportion of patients with acute endophthalmitis (88.93% vs 86.20%; p=0.76 ) presenting during the COVID-19 phase as compared to the pre-COVID-19 phase. The proportion of patients requiring inter-state travel showed complete recovery to 107% of pre-COVID-19 distribution by March 2021. Conclusion The first year of the COVID-19 pandemic saw a decline of over half the number of patients with endophthalmitis accessing eye care services. There was an increase in the presentation of endogenous endophthalmitis and a decrease in post-traumatic forms. Patients requiring inter-state travel recovered during the unlock phase.

Endophthalmitis and COVID-19: A Narrative Literature Review

“…This would theoretically lead to a heightened probability of the development of endogenous endophthalmitis. Das et al,14 indeed reported an increased frequency of endogenous cases in their institution, along with a decreased rate of posttraumatic. Additional risk factors for the development of endophthalmitis could be advanced age, concomitant health problems, such as diabetes mellitus, congenital immunodeficiencies, sepsis, tuberculosis, HIV, hepatitis, urinary infections, skin infections, keratitis, indwelling catheters, intravenous drug abuse, and the prolonged use of antibiotics, CS and immunomodulators 1,2,4,[7][8][9].…”

“…20 Some of their cases were associated with oral commensals, an unusual cause of post vitrectomy endophthalmitis. 20 Endogenous cases, on the other hand, have been on the rise 14 , especially those caused by fungal pathogens. Schroff et al, 21 reported on 5 eyes with endophthalmitis in 7 patients with severe COVID-19 pneumonia and long-term CS therapy (80-180 days).…”

“…26 Therapy included intravenous, intravitreal, and retrobulbar Amphotericin B, along with debridement of affected sinuses. 26 4 The experience with post-traumatic endophthalmitis has been more controversial -some authors, like Das et al 14 , report decreasing rates, while others -Parchand et al, 30 have observed an increase in the number of cases secondary to the higher frequency of domestic violence-related ocular trauma and late presentation.…”

“…13 Furthermore, the immune dysregulation secondary to COVID-19 predisposes to serious secondary infections, which may theoretically increase the risk of endogenous endophthalmitis. 14 The risk is additionally increased by the necessity of prolonged therapy with CS, antibiotics, and immunomodulators.…”

Year One of COVID-19 Pandemic: Effect on Presentation of Patients With Glaucoma in a Multi-Tier Ophthalmology Network in India

“…The All India Ophthalmology Society published the preferred practice guidelines for glaucoma diseases that outlined triaging patients into high risk, medium risk and low risk based on the complaints and nature of the disease, provided guidelines on intraocular pressure measurement techniques and laid down protocols related to gonioscopy evaluation, investigations, lasers and surgical procedures (7). Studies from India have helped to identify the vulnerable patients such as females, pediatric age group, elderly population and rural geography who have not been able to access eyecare services (8)(9)(10)(11)(12)(13). In this new normal we need to understand the trends of patients with chronic diseases such as glaucoma that warrants close monitoring and follow-up care.…”