新型冠状病毒肺炎防控时期眼外伤急救流程管理

2019年12月初开始于武汉的新型冠状病毒肺炎传染力强、致病率高、影响范围广,全国各地相继迅速启动紧急防控措施。新型冠状病毒肺炎防控期间,全民防疫为主,眼科疾病诊疗部分受限。眼外伤是眼科常见眼科急症,可导致不可逆转的视力丧失,甚至眼球摘除。眼外伤的急诊救治效果与患者的视力预后密切相关,需伤后短时间内做出正确诊断和及时处理。因此,新型冠状病毒肺炎防控期间如何能够安全完成眼外伤急诊的手术处理值得探讨。本文根据2020年1月24日天津市启动重大公共卫生事件一级防控响应以来,我科多例急诊眼外伤的处理流程,就疫情防控期间的眼外伤手术防控管理作一述评,以期为眼科同行在新型冠状病毒肺炎时期安全处理急诊眼外伤提供参考。     

新型冠状病毒肺炎疫情下眼科急诊感染防控管理的体会

目的总结新型冠状病毒肺炎(COVID-19)疫情下专科医院眼科急诊有效的感染防控措施。方法 2020年1月24日起从人员管理(包括医务人员和患者)、科室硬件环境、眼科器械消毒、病毒管理上报制度等方面着手,对新型冠状病毒(2019-nCoV)感染途径进行严格把控。结果共接诊1 936例眼科急诊患者(比去年同期增长21.7%),完成急诊工作的同时,所有医护人员在疫情期间无因工作原因导致2019-nCoV感染。结论思想重视、措施到位、严格把控,能够有效防范眼科医护人员感染2019-nCoV。     

新型冠状病毒肺炎疫情期间眼科手术安全性及防控对策

目的:探讨新型冠状病毒肺炎疫情期间开展眼科手术的安全性,并提出相关防控对策。方法:收集2020年1月25日至2020年2月28日新型冠状病毒肺炎疫情期间,在天津医科大学总医院眼科接受手术治疗者11例(12眼)的资料。其中眼球破裂,角膜穿孔伤,角膜穿孔伤合并外伤性白内障,眼内异物各1例(1眼),泪小管断裂2例(2眼),孔源性视网膜脱离4例(4眼),青光眼1例(2眼)。所有患者进行体温监测和流行病学调查。按照国家疫情防控要求和医院的应急管理流程,制订了眼科诊疗流程,所有患者均严格按照此流程进行管理,围手术期严格监测体温、呼吸道等全身情况。结果:11名患者就诊前行体温监测、流行病学调查、临床及影像学检查均正常,并请感染科专家会诊排除新型冠状病毒肺炎。所有患者均为眼外伤和急性眼病,包括急诊手术6眼,限期手术6眼,严格遵照眼科诊疗流程进行手术治疗,术后恢复良好,均未出现严重手术并发症。住院及随访期间患者、家属及医护人员均未发生新型冠状病毒肺炎。结论:新型冠状病毒肺炎疫情期间严格筛查患者,严格按照疫情期间防控工作流程要求,眼科手术是安全可行的。     

眼科门诊应对新型冠状病毒肺炎的管理实践

简述眼科门诊在新型冠状病毒肺炎疫情期间的管理措施。从预约就诊、预检分诊、分区管理、眼外伤等急症患者就诊处置和健康宣教方面进行门诊防控管理,同时加强医务人员防护,设备清洁消毒。希望为眼科医务工作者在新型冠状病毒肺炎疫情期,避免医患之间及患者与患者之间交叉感染提供新思路、新方法。     

新型冠状病毒肺炎疫情期间眼科急诊及手术的防控策略

新型冠状病毒(SARS-CoV-2)感染的肺炎,新型冠状病毒肺炎(COVID-19)已被中国列为按照甲类传染病管理的乙类传染病,由医院相关性传播导致的COVID-19并不少见,给临床医护人员和住院患者造成严重威胁。本文介绍眼科医生应掌握COVID-19的流行病学特点和临床表现,眼科医生如何应对眼科急诊患者,围绕眼科急诊及手术的感染防控要点和加强具体防控措施,为战疫在一线的眼科医护感染防控提供参考。     

新型冠状病毒肺炎的眼部表现

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19,新冠肺炎)是由新型冠状病毒(novel coronavirus,SARS-CoV-2,新冠病毒)引起的一种具有高度传染性的疾病,目前在世界各地广泛流行,并引起全球性恐慌。研究表明,新冠病毒可以通过眼部黏膜传播,因此眼科医务人员更容易受到感染。新冠肺炎患者眼部表现主要累及结膜、角膜、巩膜、前房、瞳孔、视网膜、视神经和视皮层、眼外肌及其颅神经支配、眼眶和泪器系统等。病毒性结膜炎是新冠肺炎患者最常见的眼部表现。新冠肺炎流行期间,为了眼科医务人员免受感染,安全地开展临床工作,本文依据近年来相关文献报道总结了新冠肺炎的眼部表现,主要包括流行病学、病理生理、临床表现等方面。     

新型冠状病毒感染防控中眼科医务工作者的防护建议

在眼病诊疗过程中与患者近距离接触,存在着新型冠状病毒交叉感染的风险。本文简介新型冠状病毒感染的特点与鉴别,从眼科医护人员个人防护、眼科门诊防控管理、眼科病房防控管理以及眼科器械清洁消毒等方面提出建议及意见,希望对眼科医务工作者在新型冠状病毒感染防控中有所帮助。     

应用氯喹和羟氯喹治疗新型冠状病毒肺炎需警惕视网膜毒性

《新型冠状病毒肺炎诊疗方案(试行第六版)》中将“磷酸氯喹”列为试用药物,各医疗机构中氯喹、羟氯喹治疗新型冠状病毒肺炎的应用也有所增加。氯喹、羟氯喹存在一定的视网膜毒性,其发生机制尚不清楚,且不同的患者对药物的耐受性也存在一定的差别,目前还不清楚其应用于新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)治疗发生视网膜毒性的风险程度。因此在应用氯喹、羟氯喹治疗COVID-19时建议根据患者的实际情况选择合适的用药剂量,并对风险较高的患者采用必要的眼科筛查以防视网膜病变的发生。本文就氯喹、羟氯喹产生视网膜毒性的风险因素、临床表现及筛查方法进行阐述,以期为更安全地应用氯喹、羟氯喹治疗新型冠状病毒肺炎提供参考。     

新型冠状病毒与眼,我们所知道的与我们应该做的

新型冠状病毒(2019-nCoV)是引起近期新型冠状病毒肺炎暴发的病原体,具有高传染性,威胁全球公共卫生健康。笔者主要就2019-nCoV的特点,眼表与呼吸道的解剖学关系,既往呼吸道病毒与眼病的研究结果,眼表的血管紧张素转换酶2受体表达以及泪液SARS病毒检测等方面进行了回顾,并就眼科执业者如何对2019-nCoV进行感染防护以及将来进一步的临床和基础研究进行了述评。     

新型冠状病毒防控中眼科医务人员的预防措施

目前新型冠状病毒(SARS-CoV-2)感染的疫情进入了一个关键期。截止2020-02-14,全国已有超过55000例新型冠状病毒感染确诊病例,给社会和经济带来极大影响,也极大地影响了眼科的日常运作。本文针对眼科门诊及病房所需的医务防护措施进行讨论和建议,以期减少在SARS-CoV-2爆发期眼科医护人员的感染。     

新型冠状病毒感染疫情下眼科诊疗工作的困难和应对措施

新型冠状病毒感染（COVID-19）是一种新发的传染性很强的乙类传染病。由于疫情突发及对新发疾病特点不熟悉,眼科医护人员在诊疗过程中与患者近距离接触存在交叉感染的风险,且面临诸多困惑。本文从疫情对医院及患者的影响、眼科医护人员的防护对策等方面探讨如何在疫情下合理、安全地开展眼科诊疗工作及相应的应对措施。（眼科, 2020, 29: 81-83）     

Epidemiology,clinical profile,management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1

Purpose:COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India’s second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management.Methods:This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021.Results:Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05).Conclusion:Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.     

COVID-19 infection with keratitis as the first clinical manifestation

AIM: To report a case which keratitis is the first clinical manifestation of COVID-19 that occurred 3d earlier than the common COVID-19 symptoms. METHODS: Regular slit lamp examination, corneal scraping test, and chest computed tomography (CT) were performed for patients with COVID-19 infection. The ophthalmologic treatment included ganciclovir eye drop (50 mg/mL, 6 times/d). The treatment for diarrhea included Guifu Lizhong pills (TID). The antiviral therapy consisted of oseltamivir (75 mg capsule Q12H); therapy preventing bacterial infection consisted of azithromycin (250 mg tablet QD) and moxifloxacin (0.4 g tablet Q12H); and therapy for cough relief and fever prevention consisted of Chinese herbal decoction. RESULTS: A 35-year-old male suddenly suffered pain, photophobia, and tears in his right eye for one day without systemic COVID-19 symptoms. Patient was diagnosed with keratitis, which was seemingly different from common keratitis. Ganciclovir eye drop was initiated. The corneal scraping test for COVID-19 was positive. The chest CT images were abnormal confirming the diagnosis of COVID-19 infection. The antiviral and antibacterial therapies were initiated. Chinese herbal therapy was used for cough relief and fever prevention. After roughly two weeks, patient recovered from COVID-19. CONCLUSION: A new type of keratitis, atypical keratitis, is a clinical manifestation of COVID-19, and this clinical manifestation could appear 3d earlier than fever and cough. The earlier a COVID-19 clinical manifestation is identified, the earlier can a patient be directed to stay at home, and significantly fewer people would be infected.     

The evidence of SARS-CoV-2 infection on ocular surface

This is a cross-sectional study of patients who received a COVID-19 diagnosis between December 30, 2019 and February 7, 2020 at Tongji Hospital. A total of 102 patients (48 Male [47%] and 54 Female [53%]) with clinical symptoms, Rt, and chest Computed Tomography (CT) abnormalities were identified with a clinical diagnosis of COVID-19. Patients had a mean [SD] gestational age of 57.63 [14.90] years. Of a total of 102 patients identified, 72 patients (36 men [50%] and 36 women [50%]; mean [SD] age, 58.68 [14.81] years) were confirmed to have COVID-19 by laboratory diagnosis with a SARS-CoV-2 RT-PCR assay. Only two patients (2.78%) with conjunctivitis were identified from 72 patients with a laboratory confirmed COVID-19. Of those two patients, SARS-CoV-2 RNA fragments were found in ocular discharges by SARS-CoV-2 RT-PCR in only one patient. Our findings suspect the incidence of SARS-CoV-2 infection through the ocular surface is extremely low, while the nosocomial infection of SARS-CoV-2 through the eyes after occupational exposure is a potential route. To lower the SARS-CoV-2 nosocomial infection, all health care professionals should wear protective goggles. The inefficient diagnostic method and the sampling time lag may contribute to the lower positive rate of conjunctival swab samples of SARS-CoV-2.     

Sudden bilateral vision loss in a COVID-19 patient: A case report

We present a Coronavirus disease 2019 (COVID-19) patient who developed sudden bilateral vision loss after a bilateral occipital ischemic stroke and without a history of stroke risk factors. An 84-year-old man was admitted to the emergency room with bilateral sudden vision loss while receiving Favipiravir treatment for 5 days following a COVID-19 diagnosis. The patient had no history of stroke risk factors, such as hypertension, diabetes mellitus, coronary artery disease, or arrhythmia. Diffusion magnetic resonance imaging of the patient revealed acute ischemia in the bilateral posterior occipital lobe and bilateral cerebellar hemisphere. We conclude that COVID-19 may rarely cause bilateral ischemic stroke presented only in the form of vision loss.     

关注新型冠状病毒肺炎期间的儿童眼健康

目前新型冠状病毒肺炎(COVID-19)在国内持续蔓延,具有极高传染性。眼部症状以结膜炎为代表,潜伏期患儿前来就诊时,极易造成医务人员感染,导致疫情蔓延。疫情期间,原则上非急重症,应择期治疗。但患儿病情需要前往医院就诊时,需做好防护措施。因恰逢假期儿童就诊高峰,为做好治疗管理与医务人员自身防护,避免疫情扩散,保护医务人员健康。现就COVID-19主要特点及小儿眼科医师如何应对COVID-19进行防护及临床工作进行述评,供临床医师参考。     

Mucor in a Viral Land: A Tale of Two Pathogens

Purpose:COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures for prevention and treatment.Methods:We conducted a retrospective, interventional study on six consecutive patients with COVID-19 who developed rhino-orbital mucormycosis and were managed at two tertiary ophthalmic referral centers in India between August 1 and December 15, 2020. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. Patients were treated with intravenous liposomal amphotericin B with addition of posaconazole and surgical debridement of necrotic tissue.Results:All patients were male, mean age 60.5 ± 12 (46.2–73.9) years, type 2 diabetics with mean blood glucose level of 222.5 ± 144.4 (86–404) mg/dL. Except for one patient who was diagnosed with mucormycosis concurrently with COVID-19, all patients received systemic corticosteroids for the treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.6 ± 9.6 (3–42) days. All patients underwent endoscopic sinus debridement, whereas two patients required orbital exenteration. At the last follow-up, all six patients were alive, on antifungal therapy.Conclusion:Mucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae. High index of suspicion, early diagnosis, and appropriate management can improve survival.