Evolving Treatment Paradigm in the Management of Diabetic Macular Edema in the Era of COVID-19

Iovino, Claudio; Peiretti, Enrico; Giannaccare, Giuseppe; Scorcia, Vincenzo; Carnevali, Adriano

doi:10.3389/fphar.2021.670468

Cited by 12 publications

(10 citation statements)

References 28 publications

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“…In conclusion, our results confirm that Ranibizumab, Aflibercept, and Dexamethasone implant are effective and safe in the treatment of DME. A therapy switch to Dexamethasone implant for patients receiving Aflibercept or Ranibizumab with minimal/no clinical benefit is recommended in an attempt to improve vision, reduce costs, and reduce the burden of injections of clinics and hospitals, especially in a pandemic era [16].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome and Drug Expenses of Intravitreal Therapy for Diabetic Macular Edema: A Retrospective Study in Sardinia, Italy

Altana

Donadu

Dore

et al. 2021

JCM

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Background: Diabetic macular edema (DME) is a leading cause of visual loss in working-age adults. The purpose of this retrospective study was to perform an epidemiological analysis on DME patients treated with intravitreal drugs in a tertiary hospital. The clinical outcome, adverse drug reactions (ADRs), and intravitreal drug expenses were assessed. Methods: All DME patients treated with Ranibizumab, Aflibercept, Dexamethasone implant, and Fluocinolone Acetonide implant at the Sassari University Hospital, Italy, between January 2017 and June 2020 were included. Central macular thickness (CMT) and best corrected visual acuity (BCVA) were measured. ADRs and drug expenses were analyzed. Results: Two-hundred thirty-one DME patients (mean age: 65 years) received intravitreal agents. Mean CMT and BCVA were 380 μm and 0.5 LogMAR at baseline, 298 μm and 0.44 logMAR after one year (p = 0.04), and 295 μm and 0.4 logMAR at the end of the follow-up period. A total of 1501 intravitreal injections were given; no major ADRs were reported. Treatment cost was €915,000 (€261,429/year). Twenty non-responders to Ranibizumab or Aflibercept were switched to a Dexamethasone implant. In these patients, mean CMT and BCVA were 468 µm and 0.5 LogMar at the time of switching and 362 µm and 0.3 LogMar at the end of the follow-up (p = 0.00014 and p = 0.08, respectively). Conclusion: Results confirm that Ranibizumab, Aflibercept, and Dexamethasone implant are effective and safe in DME treatment. A switch to Dexamethasone implant for patients receiving Aflibercept or Ranibizumab with minimal/no clinical benefit should be considered.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcome and Drug Expenses of Intravitreal Therapy for Diabetic Macular Edema: A Retrospective Study in Sardinia, Italy

Altana

Donadu

Dore

et al. 2021

JCM

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“…Authors working in a tertiary centre in Italy evidenced a reduction of up to 91.7% in intravitreal injections during the quarantine [ 20 ]. Switching from monthly anti-vascular endothelial growth factor (VEGF) injections to intravitreal dexamethasone implant in eligible patients has been suggested in order to reduce the burden of injections for hospitals [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on Eye Care in Spain during the First Phase of the Pandemic

Rodríguez-Fernández

Varela-Agra

Pérez-Roldán

et al. 2021

JCM

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Background: The declaration of the first state of alarm for COVID-19 in March 2020 provoked changes in ophthalmological care. The objective of this study was to assess its impact on reorganising care activities, the mental health of ophthalmologists and the training of residents. Methods: We sent an anonymous online questionnaire between August and October 2020 to consultant ophthalmologists and residents who were active during the state of alarm in Spain. We used Google Forms® software for data collection. We analysed responses according to the degree of regional impact. Results: We received a total of 328 responses from the 17 Autonomous Communities. We saw that 99.4% of respondents changed their work activities with 50% reductions in surgery (94.5%) and consultations (93.0%). Furthermore, 58.8% of respondents reported increased anxiety, and 29.9% transferred to support other services, with this number reaching 49.6% in the hardest-hit regions. Training programs were greatly reduced in external consultations (90.7%), and surgical training was completely cancelled (100%). Additionally, 56.5% of trainees wanted to prolong their residence periods. Conclusions: The first wave of the pandemic produced significant changes in ophthalmology services, and these changes were more pronounced in the most affected regions. It caused a negative psychological impact on a high rate of respondents and an interruption of the training of ophthalmology residents. Predictably, the negative consequences of this delay in ophthalmological care on patients will be uneven between regions.

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“…Although arterial and venous thrombotic events have been reported, no clear increase in the incidence of retinal arterial or vein occlusion has been associated with COVID-19 infection. However, several cases of retinal disorders with evolving treatment paradigms occurring at the time of COVID-19 infection have been described [ 9 , 10 , 11 ]. A recent review confirmed that the majority of the retinal findings in COVID-19 patients were cotton wool spots, flame-shaped intraretinal hemorrhages, PAMM, AMN, or retinal vein occlusions.…”

Section: Introductionmentioning

confidence: 99%

Did the COVID-19 Pandemic Increase the Incidence of Acute Macular Neuroretinopathy?

Azar

Bonnin

Vasseur

et al. 2021

JCM

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Background: Acute macular neuroretinopathy (AMN) is an increasingly diagnosed disorder associated with several diseases. The aim of this study was to report the incidence of AMN cases diagnosed during the 2020 coronavirus disease 2019 (COVID-19) pandemic year in a French hospital, and to describe their different forms. Methods: All patients diagnosed between 2019 and 2020, in Paris Rothschild Foundation Hospital, with AMN, paracentral acute middle maculopathy (PAMM) and multiple evanescent white dot syndrome (MEWDS) were retrospectively collected using the software Ophtalmoquery® (Corilus, V1.86.0018, 9050 Gand, Belgium). Systemic and ophthalmological data from AMN patients were analyzed. Results: Eleven patients were diagnosed with AMN in 2020 vs. only one patient reported in 2019. The incidence of AMN significantly increased from 0.66/100,000 visits in 2019 to 8.97/100,000 visits in 2020 (p = 0.001), whereas the incidence of PAMM and MEWDS remained unchanged. Four (36%) of these AMN patients were tested for COVID-19 and received positive polymerase chain reaction (PCR) tests. Conclusions: The incidence of AMN cases increased significantly in our institution in 2020, which was the year of the COVID-19 pandemic. All AMN-tested patients received a positive COVID PCR test, suggesting a possible causative link. According to the different clinical presentations, AMN may reflect different severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pathogenic mechanisms.

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Evolving Treatment Paradigm in the Management of Diabetic Macular Edema in the Era of COVID-19

Cited by 12 publications

References 28 publications

Clinical Outcome and Drug Expenses of Intravitreal Therapy for Diabetic Macular Edema: A Retrospective Study in Sardinia, Italy

Clinical Outcome and Drug Expenses of Intravitreal Therapy for Diabetic Macular Edema: A Retrospective Study in Sardinia, Italy

Impact of COVID-19 on Eye Care in Spain during the First Phase of the Pandemic

Did the COVID-19 Pandemic Increase the Incidence of Acute Macular Neuroretinopathy?

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