Ocular oncology service during the COVID-19 outbreak: uveal melanoma characteristics presenting in 2019 compared to 2020

Abstract

Aim We aim to evaluate the impact of the COVID-19 pandemic on ocular oncology in Ireland, comparing uveal melanoma trends in 2019 to 2020. Methods Patients included for analysis were those that presented to the ocular oncology service from January 2019 to December 2020 in the Royal Victoria Eye and Ear Hospital in Dublin, who underwent primary treatment for uveal melanoma—proton beam therapy, brachytherapy or enucleation. Results Ninety-seven patients presented in 2019 (n = 46) and 2020 (n = 51) who underwent primary treatment for uveal melanoma. Presentation via the eye casualty department was more common in 2020. Dimensions of choroidal melanomas were increased both in basal diameter and thickness compared to those in 2019. More patients had enucleations in 2020 than in 2019 (21.6% vs 9.3%, respectively) and less had proton beam therapy (6.2% vs 12.4%). More patients had evidence of extra-scleral extension at the time of surgery in 2020 compared to 2019 (4.1%, n = 4 versus 0%, respectively). The mean duration of brachytherapy therapy was longer in 2020 (5.3 days ± 35.8) compared to 2019 (4.6 days ± 38.7). Mean time between presentation and primary treatment was 35.6 ± 28.8 days in 2019 and 24.1 ± 20.4 days in 2020. Conclusions More advanced disease is suggested by the increased mean basal diameter and tumour thickness, extra-scleral extension and longer duration of brachytherapy. Time from diagnosis to treatment was not delayed in 2020.

Impact of SARS-CoV-2 (COVID-19) Pandemic on Characteristics and Management of Uveal Melanoma in National Referral Center in Poland

“…The number of T4 tumors increased from 8.78% in year 2018 to 26.26% in year 2021 and number of uveal melanomas localized anterior to the equator of the eye globe increased from 20.88% in year 2018 to 29.75% in year 2021, respectively. Our results were consistent with those from studies conducted in Spain and Ireland, where increased tumor size at diagnosis was found during the COVID-19 pandemic [17,19]. A study in the UK also found that more patients presented with more advanced cancers post lockdown [18].…”

“…[18]. However, other studies did not confirmed this finding but those studies comprised of low number of patients [17,19,20].…”

“…The COVID-19 pandemic resulted in unprecedented disruption to healthcare and restrictions taken to limit the exposure of patients to virus contagion had notable impact for non-COVID-19 pathologies including eye cancers [17][18][19][20]. The incidence of uveal melanoma varies among ethnic groups and regions around the world and has remained stable over recent decades.…”

“…The difference in results may be attributed to the regional context of the studies, with Texas having a different approach to the Covid-19 pandemic: the Texas government has never issued an isolation order [20]. Although these studies did not analyze the specific localization of uveal melanomas, researchers from Spain and Ireland confirmed a greater number of patients diagnosed with extraocular extension of tumors compared to the pre-pandemic era [17,19].…”

“…[12] The ocular manifestations of SARS-CoV-2 (COVID-19) have been reported in anterior and posterior segments of the eye, including (but not limited to) blepharitis, eyelid dermatitis, conjunctivitis, keratitis, episcleritis, retinitis, optic neuritis, papillophlebitis, panuveitis, central retinal artery/vein occlusion and Purtchner-like retinopathy [13][14][15][16] But more importantly, restrictions put in place to prevent the spread of the virus have impacted the diagnosis and treatment of chronic eye diseases and uveal melanoma is no exemption. Despite the fact that COVID-19 pandemic has had an unprecedented impact on health care systems around the world, the number of publications on the impact of COVID-19 pandemic on characteristic and treatment of uveal melanoma is limited [17][18][19][20] and most of them included small patient samples.…”