The Impact of the First COVID-19 Lockdown Period on the Inpatient and Outpatient Volume of a University Based Tertiary Referral Center with Corneal Subspecialization in Germany

Figures & data

Table 1 Ophthalmic Surgeries of Patients, Who Attended the Inpatient Unit of the Department of Ophthalmology, Saarland University Medical Center Between 18 March and 8 May (2020 and 2019)

Inpatient Surgeries	2020	2019	Fisher’s Test P-value
Eyelid surgery	5	9	P = 0.7879
Levator muscle surgery	0	6	P = 0.0454
Strabismus surgery	6	21	P = 0.0462
Pterygium surgery	3	9	P = 0.3766
Phototherapeutic keratectomy (PTK)	29	29	P = 0.1649
EDTA chelation	1	6	P = 0.2493
Suture replacements	13	6	P = 0.0178
DMEK	37	37	P = 0.1059
Penetrating keratoplasty	60	54	P = 0.0089
Amniotic Membrane Transplantation (AMT)	6	15	P = 0.2672
Crosslinking	0	1	P = 1.0000
Corneal suture removal	3	5	P = 1.0000
TE+MMC	3	2	P = 0.4075
Filtering bleb-Revision	1	1	P = 1.0000
i-Stent	0	1	P = 1.0000
CPC	9	9	P = 0.4735
Canaloplasty	7	4	P = 0.2148
Anterior chamber eye flush	9	23	P = 0.1430
Re-Bubbling after DMEK	5	14	P = 0.2388
ECCE+HKL	2	7	P = 0.3200
Phako+HKL	24	51	P = 0.1056
Secondary IOL	5	7	P = 1.0000
Scleral buckling	0	1	P = 1.0000
Exocryocoagulation	1	2	P = 1.0000
IVIs (intravitreal injection)	3	15	P = 0.0491
ppV (pars plana vitrectomy)	47	63	P = 0.7515
Anterior vitrectomy	1	2	P = 1.0000
Globe rupture surgery	1	1	P = 1.0000
Total number	281	401

Notes: P-values in Bold Indicate Statistically Significant Differences.

Abbreviations: EDTA, Ethylenediaminetetraacetic; DMEK, Descemet Membrane Endothelial Keratoplasty; TE+MMC, Trabeculectomy+Mitomycin C; CPC, Cyclophotocoagulation; ECCE+HKL, Extracapsular cataract extraction with IOL implantation; Phako+HKL, Phacoemulsification with IOL implantation.

Table 2 The Number of Consultations of Patients, Who Attended the Various Outpatient Units at the Department of Ophthalmology, Saarland University Medical Center Between 18 March and 8 May (2020 and 2019)

Number of Patients	2020	2019	Chi-Squared P-value
Cataract preoperative examination	34	137	P < 0.0001
Eyelid consultations	37	79	P = 0.4946
Keratoconus consultation	5	34	P = 0.0037
Contact lens consultation	56	220	P < 0.0001
Paediatric ophthalmology and orthoptics clinic	458	841	P = 0.7408
University outpatient clinic	1121	1883	P < 0.0001
Total number	1711	3194

Notes: P-values in Bold Indicate Statistically Significant Differences.

Table 3 The Number of Consultations, Intravitreal Injections and Diagnostic Procedure (M-OCT) of Patients, Who Attended the IVI-Center (Intravitreal Injections Center) of the Department of Ophthalmology, Saarland University Medical Center Between 18 March and 8 May (2020 and 2019)

IVI-Centre (IVI: Intravitreal Injection)	2020	2019	Chi-Squared P-value
Checkup (after the injections)	76	49	P = 0.0036
Macula-OCT	210	254	P = 0.1578
Number of patients that did not show-up	198	68	P < 0.0001
Appointments cancelled by the clinic	6	9	P = 0.5251
The number of IVI	577	768	P < 0.0001
Total number of patients	1067	1148

Note: P-values in Bold Indicate Statistically Significant Differences.

Table 4 Ophthalmic Surgeries of Patients, Who Attended the Outpatient Operation Center at the Department of Ophthalmology, Saarland University Medical Center Between 18 March and 8 May (2020 and 2019)

Outpatient Surgeries	2020	2019	Fisher’s Test P-value
Eyelid surgeries	38	87	P = 0.4959
Conjunctiva surgeries	6	5	P = 0.0813
INTACS	1	1	P = 1.0000
Crosslinking	1	5	P = 0.4810
Corneal suture removal	40	70	P = 0.0319
Phako+HKL	64	216	P = 0.0070
ICL	0	3	P = 0.5635
Total number	150	387

Note: P-values in Bold Indicate Statistically Significant Differences.

Abbreviations: INTACS, Intracorneal ring segments; Phako+HKL, phacoemulsification with IOL implantation; ICL, Implantable contact lens.

Table 5 The Number of Diagnostic Procedures Performed at the Outpatient Unit at the Department of Ophthalmology, Saarland University Medical Center Between 18 March and 8 May (2020 and 2019)

Diagnostic Procedures	2020	2019	Chi-Squared p-value
Visual field	251	487	P = 0.0264
Macula-OCT	1166	1931	P = 0.7518
Pentacam	669	1402	P < 0.0001
Endothelial cell specular Microscopy	1115	1623	P = 0.0011
Anterior Segment OCT	1545	2255	P < 0.0001
CORVIS ST (Corneal Visualisation Scheimpflug Technology)	36	319	P < 0.0001
ORA (Ocular Response Analyser)	28	299	P < 0.0001
Fluorescein angiography	2843	4222	P < 0.0001
Total number	7654	12.538

Note: P-values in Bold Indicate Statistically Significant Differences.

Abbreviation: OCT, optical coherence tomography.

Table 6 Contingency Plan for Non-Selective Basic Eye Care in Germany During the Corona Lockdown Period Developed at the Initiative of the Association of German Chief Ophthalmic Physicians (DOCH) and in Consultation with the Boards of Directors of the Retinological Society (RG), the Association of Ophthalmology Chairholders (VOL) and the German Ophthalmological Society (DOG)

The Indications and Emergencies Listed Below are Understood as Basic Recommendations that Must be Weighed in Each Individual Case and According to Available Resources
Surgical treatment within hours until the following day	-Acute retinal detachment. -Retinal holes/tears (depending on localization and vitreous status). -Endophthalmitis. -Conservatively unmanageable glaucoma/acute intraocular pressure elevation. -Globe perforation/perforating corneal ulcer. -Trauma/foreign body/eyelid wounds (eyelid edge involvement, tear duct tears). -Acute orbital hematoma/Optic compression/Pediatric orbital floor fracture. -Keratoplasty.
Operative care within days to two weeks (“Intermediary emergency”)	-Care of surgical complications. -Subretinal bleeding with involvement/threat to the macula. -Vitreous hemorrhage in suspected retinal detachment or retinal defect, Oculus melior (better eye). -Older retinal detachment/re-retinal detachment (macula detached). - Intraocular lens (IOL) dislocation in the better eye. -Macular foramen/vitreomacular traction with visual deterioration in the better eye. -Corneal ulcer. -Progressive glaucoma (better eye, severe glaucoma damage). -Malignant tumors (eg retinoblastoma), growth, ulceration, difficult localization. -Deterioration during conservative therapy (corneal hydrops, optic nerve compression, dacryocystitis). -Diplopia/Asthenopia in pathophoria/Strabismus/muscle paresis. -Intravitreal injections: Treatment according to the recommendations of the BVA (Professional Association of Ophthalmologists in Germany).
Operative care within two weeks to three months	-Severe progressive proliferative diabetic retinopathy. -Macular hole and progressive vitreomacular traction. -Hypermature/mature cataract in the better eye. -Intraocular lens (IOL) or crystalline lens dislocation. -Operations to prevent amblyopia. -Pronounced bullous keratopathy (keratoplasty). -Foreign body revisions, suture removals.
Acute conservative treatment	-Acute loss of visual acuity/visual field restrictions. -Acute uveitis (viral retinitis, toxoplasmosis, etc.). -Acute corneal pathologies (ulcers, keratitis, keratoconus etc.). -Arterial and venous retinal occlusions. -Acute optic lesions (ischemia, neuritis, etc.). -Eyelid and orbital phlegmons, orbital inflammation, dacryocystitis. -Burns/flashes. -Panretinal laser coagulation in neovascularization to prevent bleeding. -Urgent postoperative controls, Controls for retinopathy of prematurity. -Prismatic treatment of latent and manifest strabismus (risk of falling).

Notes: Please Note That “Keratoplasty” Was Grouped Within the “Surgical Treatment Within Hours Until the Following Day”.