To the Editor:
We read with interest Wickham et al. and Dervenis et al.’s recent publications demonstrating an ~60% decrease in the presentation of rhegmatogenous retinal detachment (RRD) at Moorfields Eye Hospital, London and St Paul’s Eye Unit, Liverpool, during the Coronavirus disease 2019 (COVID-19) pandemic [1, 2].
We conducted a similar, retrospective analysis of RRD operations undertaken at St Thomas’ Hospital, London, Frimley Park Hospital, Frimley and Maidstone Hospital, Maidstone between the 24 March 2020 and 24 April 2020 (inclusive) and compared this to a comparative cohort between the same dates in 2019.
St Thomas’ Hospital, London provides a tertiary referral service for patients with RRDs, including those with complex medical needs in London and the South East of England, utilising a hub-and-spoke model with Maidstone Hospital and Frimley Park Hospital for emergency vitreoretinal services, serving a combined population of 2.1 million patients.
Table 1 demonstrates the cohort characteristics in our study. A similar number of operations for RRD were undertaken during the COVID-19 pandemic (n = 33) and comparative (n = 29) cohorts, respectively. Notably, 19 operations were performed at St Thomas’ Hospital, 8 at Frimley Park Hospital, and 6 at Maidstone Hospital during the pandemic. During the comparative 2019 time period, only one surgery was performed at each Frimley Park Hospital and Maidstone Hospital, with all other operations performed at St Thomas’ Hospital. During the pandemic, patients waited for a median of 1 day for surgery. We demonstrate an increased use of local anaesthetic (p = 0.01) during the pandemic, and comparable use of vitrectomy between cohorts.
Table 1.
Cohort characteristics.
| COVID-19 cohort | 2019 Comparative cohort | |
|---|---|---|
| Number of patients | 33 | 29 |
| Age (years), mean (±SD) | 58.6 (±12.8) | 60.1 (±11.2) |
| Presenting visual acuity (LogMAR), median (IQR) | 1.00 (0.10–2.30) | 0.30 (0.00–1.90) |
| Fovea status, n (%) | ||
| Fovea on | 17 (52%) | 17 (59%) |
| Fovea off | 14 (42%) | 12 (41%) |
| Not documented | 2 (6%) | 0 (0%) |
| PVR grade, n (%) | ||
| PVR B | 2 (6%) | 2 (7%) |
| PVR C | 7 (22%) | 0 (0%) |
| Quadrants affected, mean (±SD) | 2.20 (±1.30) | 2.25 (±0.84) |
| Local anaesthetic, n (%) | 31 (94%) | 20 (69%) |
| Operation | ||
| PPV, n (%) | 31 (94%) | 26 (90%) |
| PPV-SB, n (%) | 1 (3%) | 1 (3%) |
| SB, n (%) | 1 (3%) | 2 (7%) |
Shown are the cohort characteristics for the COVID-19 cohort and comparative 2019 cohort.
PVR Proliferative vitreoretinopathy, PPV pars-plana vitrectomy, PPV-SB combined pars plana vitrectomy and scleral buckle, SB scleral buckle.
Further similarities were noted in age (p = 0.32), extent of RRD (p = 0.43) and presentation with fovea off RRD (p = 0.77) between the 2 groups. However worse visual acuity (p = 0.02) and the presence of proliferative vitreoretinopathy (p = 0.01) were identified in the pandemic cohort.
We therefore suggest a consistent presentation of RRD during the COVID-19 pandemic. Changes in management include increased, efficient provision of care locally with judicious use of general anaesthetic. We feel that this highlights the importance and ability to provide an efficient vitreoretinal emergency service during a pandemic.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Footnotes
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References
- 1.Wickham L, Hay G, Hamilton R, Wooding J, Tossounis H, da Cruz L, et al. The impact of COVID policies on acute ophthalmology services-experiences from Moorfields Eye Hospital NHS Foundation Trust. Eye. 2020;34:1189–92. doi: 10.1038/s41433-020-0957-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Dervenis N, Heimann H, Hussain RN, Chua PY, Sandinha T, Vilà N, et al. The impact of COVID policies on the vitreoretinal service in St Paul’s Eye Unit, Liverpool. Eye. 2020:1–2. [DOI] [PMC free article] [PubMed]