Impact of COVID-19 Pandemics in Patients Submitted to Glaucoma Surgery: A 3-year Comparative Report in a Hospital Center

Abstract

INTRODUCTION: COVID-19 pandemics forced the reorganization of healthcare systems in order to provide care for ill patients infected with the novel coronavirus. Ophthalmology departments had to reduce elective procedures with mobilization of resources for non-ophthalmological purposes. This study aims to describe the glaucoma surgical volume during the pandemic year and to compare with the pre-pandemic and post-pandemic period.
METHODS: A retrospective study was conducted at Hospital Pedro Hispano, Portugal, col- lecting glaucoma surgery characteristics and patient clinical and demographic data, from clinical records, from a 3-year period, between 18 March 2019 and 17 March 2022. Demographic data such as age and gender and clinical data such as glaucoma type, glaucoma surgical procedure and type of anesthesia, glaucoma staging based on Advanced Glaucoma Intervention Study (AGIS) visual score, in dB, and pre procedure intraocular pressure (IOP), in mmHg, were collected and analyzed. The primary outcomes included MD (mean deviation), IOP measured pre procedure and the number of procedures performed. The type of procedures performed was considered a secondary outcome. Three groups were analyzed and compared: the pandemic period (between 18 March 2020 and 17 March 2021), the pre-pandemic period (homologous period between 2019 and 2020) and the post-pandemic period (homologous period between 2021 and 2022).
RESULTS: The number of total glaucoma surgeries performed during the pandemic period was similar to the pre-pandemic period, where 79 and 78 glaucoma surgeries were performed respectively. In the post-pandemic period there was an increase of 45.6% in the total glaucoma surgeries that were executed at our center resulting in 115 surgeries performed. During the first quarter of the pandemic period there was a reduction of 36% in glaucoma surgeries performed in comparison with the same period in the previous year, where a gradual increment of the number of surgeries performed was observed in the following quarters. The mean pre procedure IOP in the pandemic period was 23.8 (± 9.26) mmHg, a variation of +0.42% from the pre-pandemic group with a mean value of 23.7 (± 10.1) mmHg (p=0.475). The variation between the post-pandemic [±24.6 (±9.5) mmHg] and the pandemic period pre procedure IOP was +3.25% (p=0.638). Significance level was set as p<0.05. Regarding the glaucoma staging, the mean MD in patients who underwent glaucoma surgery in the pandemic period was -14.1 dB, with a variation of -1.42% from the pre-pandemic group (p= 0.796), -2.76% was the variation from the post-pandemic group comparing with the pandemic group (p=0.813).
CONCLUSION: The total number of surgeries performed at our center during the pandemic period was similar to the number performed in pre-pandemic homologous period. There was no statistically significant difference in the mean pre procedure IOP and MD of patients that were submitted to glaucoma surgery during the pandemic period in comparison with those submitted to the same type of surgery during the pre-pandemic or post-pandemic period. It is, then, possible to conclude that, besides the necessary reorganization of healthcare systems due to COVID-19 pandemics, no significant changes were made on glaucoma patients with indication of surgery.