scholarly journals Impact of the COVID-19 pandemic’s first wave on the care and treatment situation of intravitreal injections in a German metropolitan region

2022 ◽  
Author(s):  
Birthe Stemplewitz ◽  
Joel Luethy ◽  
Mau-Thek Eddy ◽  
Martin Spitzer ◽  
Ulrike Brocks ◽  
...  
Keyword(s):  
Risk Factors ◽  
Family Environment ◽  
Diabetic Macular Oedema ◽  
Age Related Macular Degeneration ◽  
Intravitreal Injections ◽  
Metropolitan Region ◽  
Treatment Situation ◽  
Age Related ◽  
The Family ◽  
The Impact

Abstract Purpose This study aims to evaluate the impact of the first coronavirus 2019 (COVID-19) wave in 2020 on patients scheduled for intravitreal injections (IVI) in a German metropolitan region. Methods We performed a multicentre prospective survey and retrospective analysis of the records of patients treated with intravitreal injections during the 20-week period from March to July 2020 in all four hospital eye departments in the city of Hamburg using a questionnaire (on treatment adherence, SarsCoV2-related personal, familial and social data) and treatment data. Results A total of 1038 patients (2472 IVI, 1231 eyes) and 818 questionnaires were evaluated. Longer duration of therapy, lower visual acuity (VA) of the treated and higher VA of the fellow untreated eye was were associated with a higher probability of visit cancellation. Every additional year of life posed a 2.6% lower risk of noncompliance. A COVID-19 infection in the family environment displayed a 5.5-fold chance of visit cancellation. Patients treated for neovascular age-related macular degeneration (nAMD) had a 36% reduced risk of visit cancellation compared to patients with diabetic macular oedema (DME). Conclusion A long preceding treatment period, low VA of the treated eye, high VA of the untreated eye, COVID-19 in the family and DME were identified as risk factors for IVI visit cancellations during the COVID-19 pandemic. Compliance to treatment might be improved in the future by taking these risk factors into account when scheduling patients for IVI during the exceptional circumstances of a pandemic.

scholarly journals The impact of vascular risk factors on the thickness and volume of the choroid in AMD patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Elżbieta Krytkowska ◽  
Aleksandra Grabowicz ◽  
Katarzyna Mozolewska-Piotrowska ◽  
Zofia Ulańczyk ◽  
Krzysztof Safranow ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vascular Risk Factors ◽  
Age Related Macular Degeneration ◽  
Control Group ◽  
Vascular Risk ◽  
Average Volume ◽  
Central Ring ◽  
Age Related ◽  
The Impact ◽  
Wet Amd

AbstractDisturbances in choroidal microcirculation may lead to the onset and progression of age-related macular degeneration (AMD). We aimed to assess changes in the choroidal volume and thickness in the macular region in AMD eyes and to investigate whether coexisting vascular risk factors alter choroidal status. We enrolled 354 AMD patients (175 dry, 179 wet AMD) and 121 healthy controls. All participants underwent a complete ophthalmologic examination and assessment of choroidal thickness and volume. A multivariate analysis adjusted for age, sex, and smoking status revealed that wet AMD was an independent factor associated with higher average thickness of the central ring area (ATC) and average volume of the central ring area (AVC) and lower choroidal vascularity index (CVI) compared to controls (β =  + 0.18, p = 0.0007, β =  + 0.18, p = 0.0008, respectively) and to dry AMD (β =  + 0.17, p = 0.00003 for both ATC and AVC and β =  − 0.30 p < 0.0001 for CVI). ATC, AVC and average volume (AV) were lower in AMD patients with hypertension and ischaemic heart disease (IHD). The duration of hypertension was inversely correlated with ATC, AVC and AV (Rs =  − 0.13, p < 0.05; Rs =  − 0.12; p < 0.05, Rs =  − 0.12; p < 0.05, respectively) while IHD duration negatively correlated with AV (Rs =  − 0.15, p < 0.05). No such associations were observed in the control group. Our findings show that the choroidal vascular system in eyes with AMD is much more susceptible to damage in the presence than in the absence of systemic vascular disease.

scholarly journals Identification of Risk Factors and Consequences of Sexual Violence in Children

2020 ◽  
Vol 11 (01) ◽  
pp. 1-9
Author(s):  
Fenny Etrawati
Keyword(s):  
Risk Factors ◽  
Law Enforcement ◽  
Sexual Violence ◽  
Family Environment ◽  
Empirical Literature ◽  
Violence Against Children ◽  
Social Risks ◽  
The Family ◽  
Optimal Law Enforcement ◽  
The Impact

An increase in cases of sexual violence against children triggers various health problems in children, both physical, psychological and social. This paper aims to explore the sexual violence on children, risk factors and the impact of sexual violence on children. This study of sexual violence in children refers to various empirical literature studies. Furthermore, the collection of information was analyzed using the problem tree analysis approach to find out the risk factors and their impact on children. Cases of sexual violence in the community are difficult to detect because of the lack of recognition from victims. This is because the offender called pedophile comes from within the family (familial abuse) or can come from outside the family environment (extra-familial abuse) who have established close relationships with children. Sexual violence is generally motivated by the problem of weak protection from parents which is also strengthened by socio-economic problems, low access to reproductive health education and less optimal law enforcement. Therefore, children who have experienced sexual violence find it difficult to avoid physical, biological, psychological and social risks. Children who have experienced sexual violence find it difficult to avoid physical, biological, psychological and social risks. Therefore, it is necessary to increase the capacity of parents in the prevention of sexual violence against children and law enforcement needs to complete the system of early detection and rapid response to the incidence of sexual violence against children.

scholarly journals Effect of COVID-19 Pandemic on Anti-VEGF Treatment of Medical Retinal Conditions

The Physician ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. 1-9
Author(s):  
Mana Rahimzadeh ◽  
Ramu Muniraju ◽  
Shahrnaz Izadi
Keyword(s):  
Visual Acuity ◽  
Total Duration ◽  
Diabetic Macular Oedema ◽  
District General Hospital ◽  
Age Related Macular Degeneration ◽  
Intravitreal Injections ◽  
Anti Vegf ◽  
Age Related ◽  
Long Term Impact ◽  
The Uk

Introduction: Ophthalmology services have been significantly impacted by the COVID-19 pandemic. Frequency of intravitreal anti-vascular endothelial growth factor (Anti-VEGF) injections are important in visual outcomes. Methods: We conducted an audit on intravitreal services in an NHS district general hospital in the UK including all new patients with diabetic macular oedema (CI-DMO) and wet age-related macular degeneration (AMD) who were initiated on intravitreal injection of Aflibercept (EYLEA) between 1st January to 15th July 2020, and had subsequent injections until October 2020. Data on injection dates and visual acuity was extracted, and the total number of all intravitreal injections for all indications between January to September 2020 and the same period in 2019. Delay to treatment was defined as more than 14 days, according to the fixed dosing schedule. Results: We found 31% (n=17) of patients initiated on treatment for wet AMD and 44% (N=11) for CI-DMO had delayed injections.  There was no correlation between total duration of delay and change in best-corrected visual acuity (BCVA). Similarly, we found no association between duration of delay and change in BCVA. The number of intravitreal injections declined during the COVID-19 pandemic by 17.8% compared to 2019. Conclusion: Majority of patients initiated on anti-VEGF injections just before the pandemic or during the pandemic received injections on time. Where there were significant delays to treatment, there was no detected loss in vision over the short term. However, the long-term impact and impact of overall reduction in intravitreal injections are unknown.

Risk factors for incident central serous retinopathy: case–control analysis of a US national managed care population

2019 ◽  
pp. bjophthalmol-2018-313050 ◽  
Author(s):  
Maggie Zhou ◽  
Sophie J Bakri ◽  
Suzann Pershing
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Macular Degeneration ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Case Control ◽  
Age Related Macular Degeneration ◽  
Central Serous Retinopathy ◽  
Lower Odds ◽  
Age Related

AimTo evaluate clinical comorbidities and steroid use as risk factors for central serous retinopathy (CSR).MethodsUsing national insurance databases, we conducted a case–control study of beneficiaries with an incident diagnosis of CSR between 2007 and 2015 (n=35 492) and randomly selected controls matched on age-based and sex-based propensity scores (n=1 77 460).ResultsThe mean age (SD) of cases was 49.1 (12.2) years, and the majority (69.2%) were male. Cases were more likely to have received steroids in the past year (OR 1.14, 95% CI 1.09 to 1.19, p<0.001) and to have comorbid Cushing’s syndrome (OR 2.19, 95% CI 1.33 to 3.59, p=0.002), age-related macular degeneration (OR 5.24, 95% CI 5.00 to 5.49, p<0.001), diabetic macular oedema (OR 2.05, 95% CI 1.71 to 2.47, p<0.001) and diabetes mellitus (OR 1.44, 95% CI 1.33 to 1.56, p<0.001). Glaucoma was associated with lower odds of CSR (OR 0.54, 95% CI 0.51 to 0.56, p<0.001). Patients with other previously hypothesised risk factors (including essential hypertension, pregnancy, other autoimmune disease, sleep disorders, Helicobacter pylori infection and gastro-oesophageal reflux disease) had lower odds of CSR.ConclusionsMale middle-aged patients with recent steroid exposure were significantly more likely to develop CSR. Other risk factors include diabetes mellitus, diabetic macular oedema and age-related macular degeneration. Other previously hypothesised risk factors did not appear to confer increased risk. More research is needed to confirm and examine underlying pathophysiology.

scholarly journals Incidence of elevated intraocular pressure after intravitreal injection in Japanese patients with age-related macular degeneration

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maiko Maruyama-Inoue ◽  
Tatsuya Inoue ◽  
Shaheeda Mohamed ◽  
Yoko Kitajima ◽  
Shoko Ikeda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intraocular Pressure ◽  
Macular Degeneration ◽  
Intravitreal Injection ◽  
Odds Ratio ◽  
Japanese Patients ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Elevated Intraocular Pressure ◽  
History Of

AbstractThe purpose of this study was to report the incidence of elevated intraocular pressure (IOP) after intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) in Japanese patients with age-related macular degeneration (AMD). A retrospective study of chart review of patients who underwent ≥ 10 intravitreal anti-VEGF injections between April 2009 and December 2019 was conducted. Elevated IOP was defined as IOP ≥ 25 mmHg at one visit. Cases with elevated IOP resulting from IVI were identified. Furthermore, the association between elevated IOP and some parameters, as the risk factors that influence elevated IOP, was investigated. A total of 402 eyes of 370 patients were included in this study. Twenty-eight eyes of 26 patients (7.0%) were identified as cases with elevated IOP after IVI. The mean time of elevation after baseline was 50.6 ± 26.5 months. History of glaucoma (p = 0.021; odds ratio, 5.85), treatment modality (p = 0.019; odds ratio, 6.32), and total number of injections (p = 0.003; odds ratio, 1.03) were significantly associated with elevated IOP. A late complication of elevated IOP is associated with IVI in patients with AMD. Particularly, history of glaucoma and treat and extend regimen with frequent injections were found to be risk factors of elevated IOP.

scholarly journals Efficacy of Psychiatric Treatment to Treat a Specific Phobia of Intravitreal Injections in a Patient with Neovascular Age-Related Macular Degeneration

2021 ◽  
pp. 48-56
Author(s):  
Atsuta Ozaki ◽  
Hisashi Matsubara ◽  
Masahiko Sugimoto ◽  
Manami Kuze ◽  
Mineo Kondo ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Macular Edema ◽  
Psychiatric Treatment ◽  
Early Stage ◽  
Behavioral Therapy ◽  
Specific Phobia ◽  
Age Related Macular Degeneration ◽  
Intravitreal Injections ◽  
Anti Vegf ◽  
Age Related

Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) is essential for the treatment of macular diseases such as wet age-related macular degeneration and macular edema. Although continued treatment is needed to maintain good vision, some patients cannot continue such injections for various reasons, including specific phobias. Here, we report a case of a patient with a specific phobia of intravitreal injections who could resume treatment after undergoing combined drug and cognitive-behavioral therapy (CBT). A 74-year-old Japanese man diagnosed with retinal angiomatous proliferation by fluorescein angiography and indocyanine green angiography was treated with intravitreal anti-VEGF injection. However, at 8 months after the first treatment, he became difficult to treat because of a phobia of injections. He was treated with photodynamic therapy, but his macular edema did not improve. After a psychiatric consultation, he was diagnosed with a specific phobia of intravitreal injections. Combined drug and CBT enabled him to resume receiving intravitreal injections. This case demonstrates that a specific phobia of intravitreal injections may benefit from combined drug and CBT. In this regard, some patients with high anxiety and fear of intravitreal injections should be referred to a psychiatrist at an early stage.

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