Proliferative Diabetic Retinopathy Requiring Vitrectomy Over Clinic Management During COVID-19: Impact of Delayed Care.

Bennett E Ahearn, Huy Nguyen, Jeong-Hyeon Sohn
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Abstract

Purpose: This study aimed to investigate the impact of delayed retinal clinical care during the COVID-19 pandemic on the severity of proliferative diabetic retinopathy (PDR) and drivers of follow-up delay. We compared disease severity and follow-up rates of PDR patients requiring vitrectomy to those managed nonsurgically, and identified factors associated with need for vitrectomy.

Methods: The study included 739 patients diagnosed with PDR between January 1, 2018, and March 4, 2021, categorized into two groups based on outcome: vitrectomy nonvitrectomy. Statistical methods such as t-tests and chi-square tests were used to analyze differences in disease severity and follow-up rates before and after COVID-19 shutdown. A multivariate regression evaluated factors leading to vitrectomy by comparing initial ETDRS (Early Treatment of Diabetic Retinopathy Study) DR staging, disease stability, DR progression, proliferative complications, appointment intervals, follow-up variance, rescheduling rate, and no-show rate.

Results: Of the 739 patients, 202 required vitrectomy, 537 were managed nonsurgically. The vitrectomy group had more severe or unstable disease before shutdown. The interval between patient visits preshutdown was 29.76 ± 45.11 days in the vitrectomy group and 40.23 ± 56.73 days in the nonvitrectomy group (p < 0.001). Both groups experienced a significant increase in appointment intervals after shutdown, with the vitrectomy group having a greater increase. Both groups had significantly increased rescheduling rate and minimally increased no-show rate. Patient-directed rescheduling was the main driver of appointment delays. Disease factors, such as tractional retinal detachment and higher ETDRS DR staging, increased the odds of vitrectomy, while appointment burden and follow-up variability had a minimal impact.

Conclusions: Patients with more severe PDR and greater delay in appointments due to the pandemic were more likely to require vitrectomy for proliferative complications. Patient-directed rescheduling was identified as the main driver of care delays, as opposed to clinic-directed rescheduling. This study highlights the importance of maintaining regular follow-up appointments for PDR patients during pandemics.

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COVID-19期间需要玻璃体切除术的增殖性糖尿病视网膜病变:延迟护理的影响
目的:本研究旨在探讨COVID-19大流行期间延迟视网膜临床护理对增殖性糖尿病视网膜病变(PDR)严重程度的影响及延迟随访的驱动因素。我们比较了需要玻璃体切除术和非手术治疗的PDR患者的疾病严重程度和随访率,并确定了与玻璃体切除术需求相关的因素。方法:该研究纳入了2018年1月1日至2021年3月4日期间诊断为PDR的739例患者,根据结果分为两组:玻璃体切除术和非玻璃体切除术。采用t检验、卡方检验等统计方法分析停药前后疾病严重程度及随访率的差异。通过比较初始ETDRS(糖尿病视网膜病变早期治疗研究)DR分期、疾病稳定性、DR进展、增殖性并发症、预约时间间隔、随访方差、重新安排率和缺席率,多因素回归评估导致玻璃体切除术的因素。结果:739例患者中,202例需要玻璃体切除术,537例非手术治疗。玻璃体切割组在关闭前病情严重或不稳定。玻璃体切除术组和非玻璃体切除术组术前就诊间隔分别为29.76±45.11天和40.23±56.73天(p <0.001)。两组在关闭后的预约时间间隔都显著增加,玻璃体切割组的增加幅度更大。两组患者的重新预约率均显著增加,缺勤率则有轻微增加。以患者为导向的重新安排是预约延误的主要原因。疾病因素,如牵拉性视网膜脱离和较高的ETDRS DR分期,增加了玻璃体切除术的几率,而预约负担和随访变异性的影响最小。结论:更严重的PDR患者和由于大流行而延误预约的患者更有可能需要玻璃体切除术来治疗增生性并发症。患者导向的重新安排被确定为护理延误的主要驱动因素,而不是临床导向的重新安排。这项研究强调了在大流行期间对PDR患者保持定期随访预约的重要性。
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来源期刊
Korean Journal of Ophthalmology : KJO
Korean Journal of Ophthalmology : KJO Medicine-Ophthalmology
CiteScore
2.40
自引率
0.00%
发文量
84
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