Canadian Retina Society (CRS) Position Statement on Intravitreal Injections and the Management of Retinal Diseases during the COVID-19 Crisis

The Executive of the CRS has reviewed recommendations from local, national and international Medical and Ophthalmology groups regarding the management of patients and the risks to health care workers during this COVID crisis.

The below commentary has been provided by the CRS Executive and endorsed by the COS Board of Directors. These comments and recommendations are based on the “conditions on the ground” that exist today at the time of this writing.

About Us

The Canadian Retina Society is composed of members of the Canadian Ophthalmological Society whose primary area of patient care consists of surgical and/or medical vitreoretinal (VR) disease.

The mission of the Canadian Retina Society is to maintain the highest quality of patient care and teaching, particularly as it relates to the investigation and treatment of vitreoretinal (VR) disease; promote the interchange of information and scientific material and facilitate meetings of those who have a special interest in the diagnosis and management of VR pathology; work with the Canadian Ophthalmological Society on matters relating to health advocacy, health policy, and clinical guidelines on a national level.

Education

Figure 2

Figure 2.

Figure 1

Figure 1.

Title:

Scarring from the Valley

Credits:

Abhishek Sethi, BS, Monique Munro, MD, Pooja Bhat, MD

Location:

Illinois Eye and Ear Infirmary; Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago

Description:

A 26-year-old healthy Hispanic-American female who grew up in the Ohio Mississippi River Valley presented with a two-month history of decreased vision involving the right eye described as a stationary “central spot”. Her past ocular history was significant for myopia OU. On examination, visual acuity with correction was count fingers at 3 feet OD and 20/40 OS. Fundus examination OU showed no vitreous cell or haze with tilted optic nerves and peripapillary atrophy. Fundus exam was significant for wide-spread chorioretinal scarring OD (Figure 1). Retinal findings were purely unilateral. Fluorescein angiography demonstrated staining of the multifocal scars scattered throughout the fundus with leakage from the juxtafoveal scar concerning for an active choroidal neovascular membrane (CNVM). Optical coherence tomography (OCT) showed subretinal hyperreflective material with intraretinal fluid OD (Figure 2).

The patient was diagnosed with Presumed Ocular Histoplasmosis (POHS) complicated by a CNVM. POHS is theorized to be an immune response to the yeast variant of Histoplasma capsulatum, which predominates along the Ohio and Mississippi River Valleys1. Patients tend to be asymptomatic unless a CNVM develops, which is found in approximately 3.8% of patients with POHS-related chorioretinal scarring2. Patients are traditionally observed unless a vision threatening CNVM develops3.

The patient received an intra-vitreal bevacizumab injection OD. Four weeks later, vision was unchanged with development of a serous pigment epithelial detachment (PED) in association with the prior observed fibrovascular CNVM. Further injections were not recommended as the visual gain was minimal due to chronicity of the CNVM given the fibrotic response. At recent examination, one-year post-presentation, there was minimal coalescence of the fibrovascular CNVM and PED, and vision has remained stable.

1 Diaz RI, Sigler EJ, Rafieetary MR, et al. Ocular histoplasmosis syndrome. Surv Ophthalmol. 2015; 60(4): 279-95.

2 Lewis ML, Van Newkirk MR, Gass JD. Follow-up study of presumed ocular histoplasmosis syndrome. Ophthalmology. 1980; 87(5): 390-9.

3 Nielsen JS, Fick TA, Saggau DD, et al. Intravitreal anti-vascular endothelial growth factor therapy for choroidal neovascularization secondary to ocular histoplasmosis syndrome. Retina. 2012; 32: 468-72.

The Canada Retina Society publishes an interesting and educational vitreo-retinal case monthly. We welcome submissions for consideration; please contact us at:

Snapshot of the Month Editors:

  • Ananda Kalevar, MD, University of Sherbrooke
  • Jason Noble, MD FRCSC, University of Toronto

Please note that the CRS reserves the right to edit Snapshot of the Month submissions

Professional Development

February 4, 2021

To our Valued Industry Partners:

At this time of year, traditionally our Board and staff would be gearing up to welcome you to our Annual Meeting. Due to the COVID-19 pandemic, the CRS Scientific Planning Committee is pivoting to organize a virtual meeting for Fall, 2021. Should circumstances change and the pandemic allow, we are also making tentative plans for small face-to-face gatherings to allow for more concentrated discussion and camaraderie during the Annual Meeting.

We acknowledge that a virtual meeting is a significant step-change from our traditional format, and we want to ensure we provide value in content and connection to both our physician and industry attendees. Your experiences and learnings from the past ten months of virtual meetings are valuable, and we welcome your comments and suggestions for how we can most effectively meet your expectations.

We appreciate your support and attendance at previous CRS events, and we look forward to connecting with you in a new and exciting format this year.

Sincerely,

Varun Chaudhary MD, FRCSC

Co-Chair, Scientific Planning Committee

2021 Canadian Retina Society Annual Meeting

Robert Gizicki MD, FRCSC, DABO

Co-Chair, Scientific Planning Committee

2021 Canadian Retina Society Annual Meeting

Canadian Retina Society Board Members

Amin Kherani, MD

Amin Kherani, MD

Alberta

President

Cynthia Qian, MD

Cynthia Qian, MD

Québec

Vice-President

James Whelan, MD

James Whelan, MD

Newfoundland

Past-President

Arif Samad, MD

Arif Samad, MD

Nova Scotia

Secretary-Treasurer

Alan Berger, MD

Alan Berger, MD

Ontario

Director, Advocacy

Varun Chaudhary, MD

Varun Chaudhary, MD

Ontario

Director, Continuing Professional Development

Robert Gizicki, MD

Robert Gizicki, MD

British Columbia

Co-Chair, Scientific Meeting

Jason Noble, MD

Ontario

Past Co-Chair, Scientific Meeting

Adverse Event Reporting

Click the following link to submit an adverse event report to CRS.