Name

Effet du confinement sur les urgences inflammatoires oculaires dans un centre de référence lors de la première vague de la COVID-19

We aimed to know if either or not uveitis patients needing urgent care had any loss of chance due to the first French lockdown, as such impact has been described for retinal detachment and other emergencies like stroke and myocardial infarction.

In this retrospective, observational and analytic study, we report data from uveitis emergency consultations in our tertiary center over the month of March, April and May 2020, i.e a period starting two weeks before the first lockdown in France and ending two weeks after it. Uveitis patients were divided in three groups depending on consultation date: before lockdown (period 1), lockdown period (period 2), and after lockdown (period 3). Studied variables were age, residency, delay to first consultation, referred patients, established patients, severity, hospitalizations, macular oedema, and infectious cause. Number of non-inflammatory emergencies is also presented, to report an overall analysis on emergency frequentation in ophthalmology during this period.

From March 02 to May 29, 495 patients consulted in our emergency service, among whom 216 urgent cases of uveitis. In uveitis patients, consultation delay was increased during lockdown period (p<0.001). Twenty-seven (11%) patients were hospitalized, with an increase during period 3 (23%; 8.3% during period 1, 10% during period 2, p= 0.03).  Among hospitalized patients, consultation delay tended to increase from 3.50 [1.75; 5.50] before lockdown to 10.0 [5.00; 30.0] during and 10.5 [7.00; 14.8] after lockdown, although not significantly (p=0.12). “Severe” composite criterion was met for 69 patients (32%; 25% in period 1, 35% in period 2, 34% in period 3) without difference (p=0.4). While Number of non-inflammatory consultations were significantly linked with period (p<0.01), with lower visits during lockdown period, number of uveitis consultations wasn’t significantly different (p=0.53) with a mean of 3.49 ±2.26 consultations per day overall.

In our service, consultation delay raised during lockdown for urgent uveitis cases. Hospitalizations increased after lockdown for these patients, with a numerical but non-significant raise in delay among these patients. The number of urgent consultations (inflammatory and non-inflammatory) decreased during the lockdown period, to rise again. Several studies had shown the negative impact on Covid-19 and lockdown on urgent pathologies, and psychological and accessibility concerns are thought to be involved.

This study shows the negative impact of lockdown period on uveitis patients, with a raise in consultation delay and effect on hospitalizations.