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。     

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。     

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门诊疾病谱分析及防疫处理对策

目的　探讨新型冠状病毒肺炎（COVID-19）疫情下眼科门诊疾病谱变化趋势及防疫处理对策。方法　采用整群抽样法,以2020年1月1日至2月9日眼科门诊患者为研究组,以2019年同期就诊患者为对照组。根据ICD-10标准对两组人群进行门诊疾病谱变化趋势分析。结果　2020年1月20日以前患者病例数及前十位病种分布及构成比较前无明显改变,但1月20日以后患者病例数明显减少,前十位病种分布及构成和就诊年龄改变明显。结论　疫情期间眼科仍有较多平诊患者,需加强宣教和咨询辅助工作以进一步减少人群流动,对来诊患者,采取针对性防治措施,切断传染途径,避免疾病传播。     

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。     

眼科门诊医护人员对于新型冠状病毒肺炎的防护对策 △

目的 探讨在新型冠状病毒肺炎(COVID-19)疫情期间,眼科门诊医护人员的防控对策。方法 采用调查问卷的方法收集2020年1月1~24日、1月27日~2月2日、2月25日~3月25日眼科门诊就诊患者及医护人员的情况,包括患者的体温、流行病学史、疫区或外来人员接触史、目前症状(发热、咳嗽、乏力、眼红、分泌物等)以及近期接触人员的接触史等。同时制订COVID-19防控应急预案,进行医护人员眼部及全身防护,眼科器械清洁消毒制度。结果 COVID-19疫情初发期间(1月1~24日)我院眼科门诊接诊6 564例患者,每天共16名医护人员接诊患者;疫情高峰期间(1月27日~2月2日)共接诊262例患者,每天共8名医护人员参与接诊;疫情后期(2月25日~3月25日)共接诊4 503例患者,每天共16名医护人员参与接诊。通过进行医护人员眼部及全身防护、眼科器械清洁消毒等措施,截止目前眼科门诊未发现患者及医护人员感染病例。结论 COVID-19疫情期间,加大筛查力度,完善眼科门诊检查仪器设施消毒制度,保障了医护人员的安全。     

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。     

新型冠状病毒肺炎疫情下眼科诊疗工作的风险及防护分析

目前,眼科医务工作者在做好新型冠状病毒肺炎抗疫工作的同时,还要完成好眼科疾病的诊治工作。为了有助于大家更加高效安全地完成各项工作,本文特对新型冠状病毒肺炎疫情下眼科诊疗工作的风险及防护进行分析,并提出建议供参考。     

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。     

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.     

Retinal manifestations in patients following COVID-19 infection: A consecutive case series

Purpose:To describe retinal manifestations seen in patients associated with COVID-19 infection at a multi-specialty tertiary care hospital in Southern India.Methods:In this retrospective chart review, all consecutive cases presenting to the Retina-Uveitis service from May 2020 to January 2021 with retinal manifestations associated with COVID-19 infection or its sequelae or as a result of treatment given for COVID-19 were included.Results:Of the 7 patients, 3 were female, and 4 were male. Four patients had onset of symptoms during the active phase of COVID-19 infection. Four had bilateral and three had unilateral involvement. The manifestations ranged from mild to vision threatening. Vision threatening manifestations included infections: endogenous endophthalmitis, candida retinitis and tubercular choroidal abscess and bilateral pre-foveal hemorrhages. Milder manifestations included paracentral acute middle maculopathy, central serous chorio-retinopathy and voriconazole induced visual symptoms. Final visual acuity was 6/36 or better in the four severe cases and 6/9 or better in the mild cases.Conclusion:This study highlights the retinal manifestations associated with COVID-19 infection and its sequelae. As these patients presented with an association with COVID-19 (either during or after recovery), ophthalmologists should be vigilant and screen for such entities in case of complaints of visual symptoms or in the presence of systemic sepsis. The outcomes can be good with prompt and aggressive management.     

Comparison of ocular trauma between normalized and the COVID-19 epidemic periods in China: a multi-center cross-sectional study

AIM: To compare the feature of ocular trauma between normalized period and the COVID-19 epidemic period in China, and to provide a profile for eye injuries in special times in future. METHODS: This is a multi-center cross-sectional study with 30 participated hospitals involving the China Ocular Trauma Society members. All hospitalized cases who visited the Ophthalmology Department in participated hospitals with eye injuries during the normalized period (2019) and the COVID-19 epidemic period (2020) were included in this study. Demographic characteristic of cases, date of injury, sites and types of injury were collected. RESULTS: This study involved 13 525 (61 cases with both eyes) injured cases. There were 7269 (53.74%) eye-injured cases and 6256 (46.26%) eye-injured cases in 2019 and 2020 separately. Compared with 2019, the incidence of ocular trauma in retirees, housewives and unemployed increased with year-on-year of 4.96%, 102.67%, and 11.64% among all occupations. In 2020, the incidence of eye injuries decreased in all injury sites except for an increase in home (30.29% year-on-year). The incidence of mechanical eye injuries decreased, while that of non-mechanical eye injuries (chemical/thermal/radiation) increased (47.45% year-on-year). There were 255 (3.51%, 255/7269) and 376 (6.01%, 376/6256) non-mechanical injured cases in 2019 and 2020 (Pearson Chi2=47.33, P<0.001) separately. CONCLUSION: During the COVID-19 epidemic period, the total cases of ocular trauma decrease but the proportion of non-mechanical ocular trauma increase. Penetrating is still the highest proportion among all types of mechanical ocular trauma. From a preventive point of view, protection for retired persons, housewives and unemployed persons should be improved during public health events period.     

关注新型冠状病毒肺炎与眼表传播问题

自2019年岁末以来,新型冠状病毒感染的肺炎(COVID-19)疫情在中国武汉快速传播并引起中国和国际社会的广泛关注。目前已有尚未确认的线索认为结膜可能是新型冠状病毒(SARS-CoV-2)感染的通道之一,因此关于COVID-19感染方式以及SARS-CoV-2是否通过眼表组织进行传播的问题也成为新的关注点。由于目前尚缺乏SARS-CoV-2在眼部感染的临床观察资料和实验室研究证据,因此对引起流行性疾病的病毒引起眼部病变的部分文献进行回溯和分析则更有助于我们在COVID-19疫情防控过程中对眼部及相应的工作环境和器械采取合理的防护措施。     

Recomendaciones para la atención oftalmológica durante el estado de alarma por la pandemia de enfermedad por coronavirus COVID-19

ObjectiveMinimize exposure to the SARS-CoV-2, reduce the chances of cross-transmission between patients and healthcare personnel, and prevent the development of postoperative complications from the management of patients with eye diseases during the 2019 coronavirus disease pandemic (COVID-19).MethodsCOVID-19 literature review and consensus establishment between different Spanish ophthalmology societies in order to provide guidelines and recommendations of maximum resources primarily conditioned by the state of alert, confinement and social distancing that occurs in Spain since March 16, 2020.ResultsThe recommendations will promote the adoption of action and protection measures for eye care in outpatient clinics, surgical areas and hospitalization, for unconfirmed (asymptomatic and symptomatic) and confirmed COVID-19 patients. Measures must be adapted to the circumstances and availability of personal protective equipment in each of the centers and Autonomous Communities, which will be updated according to the pandemic phases and the measures adopted by the Spanish Government.ConclusionsDuring the COVID-19 pandemic, attention to the potential health risks to the population caused by coronavirus should prevail over the possible progression of the common eye diseases. Ophthalmologists and other eye care professionals must assume a possible progression of these diseases due to the impossibility of adequate patient follow-up.     

新冠肺炎疫情期密集线上教学对配戴角膜塑形镜儿童近视的影响

目的：研究新型冠状病毒肺炎疫情期间密集线上教学对配戴角膜塑形镜的中小学生近视的影响。

方法： 本研究为回顾性研究,选取2020-02/08在陆军军医大学第一附属医院门诊随访的配戴角膜塑形镜的中小学生77名,问卷调查统计疫情期间(2020-02/05)和学校期间(2020-05/08)网课时间、堂课时间、非学习使用电子产品时间、户外活动时间、作业时间、睡眠时间等,测量疫情期间和学校期间眼轴(AL)长度的变化,分析上网课对儿童眼轴增长和近视的影响。

结果：小学组疫情期每天上网课和学校期每天上堂课的时间分别为2.69±1.02、4.07±0.78h(P<0.001),近距离用眼总时间分别为6.67±1.82、6.31±1.19h(P=0.246); 中学组疫情期每天上网课和学校期每天上堂课时间分别为4.35±1.59、6.33±0.66h(P<0.001),近距离用眼总时间分别为9.19±2.46、7.85±0.81h(P=0.010)。小学组疫情期间和学校期间右眼AL增长分别为0.15±0.09、0.06±0.06mm(P<0.001),左眼AL增长分别为0.12±0.16、0.07±0.09mm(P=0.048)。中学组疫情期和学校期间右眼AL增长分别为0.08±0.08、0.05±0.05mm(P=0.242),左眼AL增长分别为0.13±0.09、0.04±0.06mm(P<0.001)。研究结果表明疫情期间近距离使用电子产品的时间和用眼总时间明显增加,眼轴增长较学校期间加快,近视度数快速增加。

结论：新型冠状病毒肺炎疫情期间中小学生密集线上教学使近距离使用电子产品的时间增加,AL增长较学校期间明显加快,刺激近视度数快速增长。     

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。