Abstract
The COVID-19 pandemic disrupted the regular injections of anti-vascular endothelial growth factor (anti-VEGF) in patients with various retinal diseases globally. It is unclear to what extent delayed anti-VEGF injections have worsened patients’ visual acuity. We performed a meta-analysis to assess the impact of delayed anti-VEGF injections on the best-corrected visual acuity (BCVA) in patients with neovascular age-related macular degeneration (nAMD), retinal vein occlusion (RVO), and diabetic macular edema (DME). We searched four computer databases (EMBASE, MEDLINE, Web of Science, Scopus) from inception to January 5, 2022. Data were pooled using the random-effects model. Results were reported by less than 4 months and 4 months or longer for the time period between the first injection during the pandemic and the last pre-pandemic injection. All BCVA measures were converted to the logarithm of the minimum angle of resolution (logMAR) for analyses. Among patients who received injections 4 months or longer apart, the mean difference in BCVA was 0.10 logMAR (or 5 ETDRS letters) (95% confidence interval [CI] 0.06∼0.14) for nAMD patients, 0.01 logMAR (or∼ 1 ETDRS letter) (95% CI -0.25∼0.27) for RVO patients, and 0.03 logMAR (or ∼1 ETDRS letters) (95% CI -0.06∼0.11) for DME patients. These results suggest that patients with nAMD needing scheduled anti-VEGF injections may require priority treatment over those with RVO and DME in the event of disturbed anti-VEGF injections from COVID-19 lockdowns or similar scenarios.
Keywords: COVID-19; Diabetic macular edema; Neovascular age-related macular degeneration; Retinal vein occlusion; Systematic review and meta-analysis.
【저자키워드】 COVID-19, Diabetic macular edema, retinal vein occlusion, Systematic review and meta-analysis., Neovascular age-related macular degeneration, 【초록키워드】 Treatment, Meta-analysis, pandemic, lockdown, COVID-19 pandemic, database, Patient, edema, patients, Anti-VEGF, Age-related macular degeneration, Diabetic, endothelial, Web of Science, 95% CI, 95% confidence interval, measure, injection, logarithm, random-effects model, growth factor, visual acuity, Retinal disease, retinal vein, Result, performed, reported, less, searched, analyses, the mean, anti-vascular, Retinal, worsened, 【제목키워드】 Meta-analysis, COVID-19 pandemic, systematic review, Patient, Anti-VEGF, injection, visual acuity, Delayed, changes in,