Despite the rest of ophthalmology shutting down last spring and summer based on the American Academy of Ophthalmology’s COVID-19 guidance, vitreoretinal physicians never stopped, owing to the emergent and urgent nature of our practice. However, our volume certainly decreased during this time period.

A recent paper from some leading retinal institutions indicated that intravitreal injections decreased by 39%, lasers and cryotherapy by 80%, retinal detachment repair by 59%, and other vitrectomies by 84% with the maximal decreases occurring during early April 2020.¹ Although some of these numbers do not surprise me, the retinal detachment repair numbers did, especially because many patients were not getting laser or cryotherapy. Like the decreases in stroke, heart attack, and other medical emergency admissions reported during the pandemic, RD repairs also decreased. But the number of patients having these issues most certainly did not. So, what happened to the patients? Will we see a follow-up paper on the incidence of PVR after COVID-19 delayed RD surgery? The study’s authors did not address these issues, but it does make one wonder.

There is obviously no biologic rationale for the lower RD surgery rate. COVID-19 doesn’t prevent RD, and the lack of activity postulated by some authors does not reduce the incidence of retinal tears to such an extent. Similar to the 40% reduction in heart attack admissions, were patients just toughing it out at home? Were they willing away the fact that their vision was getting progressively worse? A study in Canada showed just that, with a significant increase in macula-off detachments when comparing pre-COVID to post-COVID times, and worse presenting visual acuity.² Interestingly, the rate of RD repair was not as greatly affected as the US institutions from the previous study. Others have published that the rates of PVR were higher and delays in treatments were prevalent.

In this issue, we take another look at the impact of COVID-19 using the Vestrum database, paying particular attention to intravitreal injections. The findings are very interesting and may have implications on how often we treat; many patients obviously missed injections but maintained vision while others fared much worse. I am sure we will see many papers in the upcoming months exploring the features of patients who did better, and this may change our treatment regimens even further. Certainly, the pandemic accelerated home monitoring devices and algorithms, which is a very good thing.

In our surgery issue, we explore bread-and-butter procedures, such as dislocated IOLs, as well as more complicated procedures such as vitrectomy in the setting of choroidal melanoma. We look at surgical complications and methods to reduce as well as treat them. Finally, we explore sustained-release dexamethasone implants to treat postsurgical inflammation. We always enjoy putting together the articles for our surgery issue and hope you enjoy the issue. RP

REFERENCES

1. Breazzano MP, Nair AA, Arevalo JF, et al. Frequency of urgent or emergent vitreoretinal surgical procedures in the United States during the COVID-19 pandemic [published online ahead of print, 2021 Mar 4]. JAMA Ophthalmol. 2021;e210036. doi:10.1001/jamaophthalmol.2021.0036
2. Arjmand P, Murtaza F, Eshtiaghi A, Popovic MM, Kertes PJ, Eng KT. Impact of the COVID-19 pandemic on characteristics of retinal detachments: the Canadian experience. Can J Ophthalmol. 2021;56(2):88-95. doi:10.1016/j.jcjo.2020.12.008