Management of retinoblastoma during the Covid-19 pandemic: Experience at a tertiary care centre.
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Background Covid-19 disease and the imposed lockdown adversely affected patient care at healthcare facilities worldwide. Children affected with retinoblastoma require uninterrupted care due to systemic immunosuppression and the chances of disease relapse. We evaluated the impact of Covid-19 on patients with retinoblastoma and report a strategy to mitigate this impact. Methods We reviewed records of patients attending the ophthalmic emergency from March 2020 to March 2021. Patients with retinoblastoma were categorized based on their urgency level, and managed as per the treatment protocol. The relevant demographic data, clinical profile, referral details, and management strategy used were recorded and analysed. Results Fifty patients with retinoblastoma were reviewed (males 31 [62%], mean age 3.33 years). After Covid-19 screening, an ophthalmic examination was done, and an ocular diagnosis was established. The categorization was: 1 emergent, 21 urgent, 26 semi-urgent, and 2 non-urgent patients. Of the 47 patients tested for Covid-19, two were positive and the intervention was deferred. An intervention was delivered in 41 patients (1 orbital biopsy, 9 enucleation, 27 focal therapy, 4 systemic chemotherapy), and 9 received no intervention. A 78.7% reduction in new patients was seen in attendance of the retinoblastoma clinic (p=0.02). All healthcare professionals used personal protective equipment. Teleconsultations were encouraged wherever possible. Support of non-governmental organizations was sought for patient mobilization. Conclusion The described model exemplifies a strategy to mitigate the impact of Covid-19 and lockdown on healthcare delivery to patients with retinoblastoma for a year.