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。     

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。     

新冠肺炎疫情居家隔离期间角膜塑形镜配戴行为调查及对近视控制效果的研究

目的 比较新冠肺炎疫情前和疫情居家隔离期间角膜塑形镜控制中小学生近视进展的效果,以及新冠肺炎疫情居家隔离期间角膜塑形镜配戴依从性及不同户外活动时间下中小学生近视进展控制的效果.方法 回顾分析在我院眼科视光门诊就诊的配戴角膜塑形镜的中小学生115例,调查患者新冠肺炎疫情居家隔离期间配戴角膜塑形镜的依从性及用眼方式、户外活...     

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。     

软性角膜接触镜在治疗角膜穿孔中的应用

目的评价软性角膜接触镜在治疗角膜穿孔中的效果。方法9例(9眼)新鲜角膜穿孔伴前房消失,其中角膜溃疡致穿孔7例,角膜穿孔伤2例。所有患眼均配戴软性角膜接触镜治疗。戴镜期间根据不同病例选择用药,接触镜每周消毒1次。结果所有患眼1~2 d内前房恢复,22~40 d角膜溃疡愈合,5例病灶见新生血管长入,1例角膜溃疡前房反复消失,后行穿透性角膜移植,2例角膜穿孔伤口对合整齐。结论软性角膜接触镜在治疗角膜小穿孔中是一种安全有效的辅助治疗方法。     

国产透明质酸钠在显微眼外科的临床应用

透明质酸钠成功的应用于显微眼外科是现代眼科的重要成就之一。上海医大眼耳鼻喉科医院与卫生部上海生物制品研究所共同研制的透明质酸钠(Hyalurona),经过严格地国际通用的理化性质分析后,以及在合格的动物实验达标的基础上,于1988年6月用于眼科临床白内障囊外摘除同时置入后房型人工晶体14例(14眼),恶性青光眼手术1例(1眼),和角膜穿孔伤修补术1例(1眼),均获得满意效果,现报告如下。     

新型冠状病毒核酸检测在眼科医院疫情防控中的实践与有效性研究

目的:探索以系统化、标准化的新型冠状病毒核酸检测为核心和重要组成部分,建立适合于眼科医院新冠疫情精准防控切实可行的防控体系。方法:系列病例研究。自2020年2月24日至3月2日期间,以标准化病毒核酸检测联合血常规、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)等检测作为所有眼科手术患者术前筛查常规检测项目,同时也为返岗员工提供病毒核酸检测。设计调查问卷了解受检者对鼻咽拭子采样的接受度以及核酸检测结果对其心理状态的影响。结果:99例患者血液学检测结果有一定的异常比例,其中SAA检测结果增高13例,淋巴细胞计数减低12例、增高5例,白细胞计数增高11例、减低1例,CRP增高2例,新型冠状病毒核酸检测均阴性。33例本院职工新型冠状病毒核酸检测均阴性。12%的受访者对鼻咽拭子采样接受度评分较低。受检者在核酸检测前后思想压力评分较高的比例分别为46.7%和6.7%。结论:该项举措一方面为术前新冠病毒肺炎筛查及鉴别诊断提供了客观依据,很大程度上排除了隐性无症状感染者传播的可能,有利于减少二次传播的风险,降低院内交叉感染的概率;另一方面,核酸检测阴性结果有利于调整患者术前的心理状态并缓解医护人员在疫情防控期间的心理压力。     

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。     

0.1％溴芬酸钠滴眼液在SMILE术后的早期疗效

目的 比较0.1％溴芬酸钠滴眼液(普罗纳克滴眼液)与0.3％妥布霉素/0.1％地塞米松滴眼液(典必殊滴眼液)在SMILE术后的抗炎作用及安全性.方法 前瞻性临床对照研究.将2013年9月至2013年10月在中山大学中山眼科中心激光近视眼治疗中心接受SMILE手术的患者60例(120眼)分为2组:普罗纳克组30例和典必殊组30例.普罗纳克组术后第1天开始滴用溴芬酸钠滴眼液,每天2次,使用2周;典必殊组术后第1天开始滴用妥布霉素地塞米松滴眼液,每天4次,使用1周,作为对照.分别于术前,术后1周、1个月及3个月定期观察患者视力、屈光度、眼内压、中央角膜知觉及泪膜破裂时间(BUT)、角膜荧光染色和泪液分泌试验(Schirmer'sⅡtest)及国际眼表面疾病指数(OSDI)等干眼参数变化情况.数据采用重复测量的多因素方差分析和多重比较分析.结果 SMILE术后使用溴芬酸钠滴眼液与使用妥布霉素地塞米松滴眼液,在对术后UCVA、BCVA、角膜中央知觉、干眼参数(BUT、Schirmer'sⅡtest、OSDI)及角膜荧光染色等方面差异均无统计学意义.在SMILE术后1周时,普罗纳克组平均眼内压为(12.51 ±2.45) mmHg,明显低于典必殊组[(15.57±2.54)mmHg],差异有统计学意义(F=45.409,P＜0.05).在观察期间,普罗纳克组眼内压保持在一平稳水平,典必殊组停药后眼内压逐渐恢复.结论 SMILE术后应用0.1％溴芬酸钠滴眼液可以达到与妥布霉素地塞米松滴眼液同样的治疗效果,而相对于妥布霉素地塞米松滴眼液,溴芬酸钠滴眼液没有明显的升高眼内压作用,可作为SMILE术后一种既安全又有效的药物.     

Preoperative COVID-19 testing for elective vitreoretinal surgeries: Experience from a major tertiary care institute in South India

Purpose:To study the prevalence of asymptomatic SARS-CoV-2 virus infection (COVID-19) among patients undergoing elective vitreoretinal surgeries at a tertiary care eye hospital.Methods:This cross-sectional, observational study was performed between July 16, 2020 and August 31, 2020, in the retina clinic of a tertiary care eye hospital in south India. All patients undergoing elective retinal surgical procedures underwent RT-PCR testing for SARS-CoV-2 before being posted for surgery and after obtaining informed consent. Patients planned for surgery under general anesthesia underwent additional computed tomography of the chest. Testing strategies and outcomes were documented.Results:Out of a total of 413 patients who were given appointments for surgery during this period, nine patients (2.2%) were found to have positive RT-PCR for SARS-CoV-2, and their surgeries were postponed. The test positivity (prevalence) rate of asymptomatic COVID-19 infection among all elective vitreoretinal surgical patients in our hospital was 2.2%. None of the patients were symptomatic for COVID-19.Conclusion:Our results showed that among patients visiting high volume ophthalmic centers in the near future, approximately 1 in 45 patients may be asymptomatic, SARS-CoV-2 RT-PCR positive. Asymptomatic COVID-19 patients may lead to chances of transmission of the virus inside healthcare facilities among other visiting patients and healthcare workers.     

COVID-19爆发期武汉原发性急性闭角型青光眼的手术治疗

目的：总结新型冠状病毒肺炎(COVID-19)疫区原发性急性闭角型青光眼患者的特点和救治方法。

方法：回顾性分析2020-03-02/20疫情期间我院治疗的原发性急性闭角型青光眼患者5例9眼的病历资料,慢性进展期8眼施行白内障超声乳化人工晶状体植入联合房角分离术,临床前期1眼施行激光虹膜周切术。分析手术前后眼压、视力及并发症等情况,总结患者特点及诊治体会。

结果：原发性急性闭角型青光眼患者5例中3例为双眼发病,发病时间12～40(25.2±11.82)d; 白内障超声乳化人工晶状体植入联合房角分离术后眼压(12.63±1.68mmHg)较术前(48.38±3.22mmHg)明显下降(t=12.192,P<0.01); 住院天数2～6(平均3.8±1.48)d。5例患者均未发现感染及手术相关并发症。

结论：在COVID-19疫情期间,疫区原发性急性闭角型青光眼慢性进展期患者发作时间长、病情重,双眼发作比例高; 白内障超声乳化人工晶状体植入联合房角分离术可以安全、有效地降低原发性急性闭角型青光眼患者的眼压; 疫情期间规范的防控措施可有效保障医患安全,但加大手术难度。     

COVID-19疫情期间采用气体负压引流缓解眼科手术中患者佩戴医用口罩导致的呼吸不适

目的：报告COVID-19疫情期间局部麻醉下眼科手术的预防措施,评估眼科手术中佩戴医用口罩患者的呼吸情况。

方法：招募60例需要眼科手术治疗的中国患者,在眼科局部麻醉手术期间给予医用口罩作为COVID-19预防措施之一。采用吸氧和气体负压引流的方法缓解患者佩戴口罩存在的潜在呼吸不适感,并进行呼吸舒适度评分。

结果：佩戴医用口罩患者出现轻到中度呼吸不适,总体平均得分为2.34±0.73分。吸氧和气体负压引流缓解了呼吸不适(总平均得分为0.15±0.75分,P<0.001)。呼吸不适或呼吸不适缓解度不存在性别和手术时间差异。术中出现负压气体引流失败会导致严重呼吸不适。

结论：吸氧和气体负压引流可维持局部麻醉下佩戴医用口罩患者的呼吸循环。在COVID-19疫情期间建议接受眼科局部麻醉手术的患者佩戴医用口罩,以保护眼科医护人员。     

飞秒激光和角膜板层刀制瓣LASIK术后临床效果的比较

目的：观察飞秒激光和角膜板层刀制瓣准分子激光原位角膜磨镶术(LASIK)术后的临床疗效。

方法：对本院眼视光中心行飞秒激光和角膜板层刀制瓣LASIK术的近视患者各50例100眼在术后1、3、6mo做裸眼视力、残余屈光度、干眼症调查、高阶像差检查。

结果：两组的裸眼视力及残留屈光度在术后6mo内差异均无统计学意义(P>0.05); 干眼症状调查显示：术后1、3mo,两组比较差异均有统计学意义(P<0.05); 术后6mo两组比较,差异无统计学意义(P>0.05); 两组术后1、3、6mo高阶像差与术前对比均增大,差异有统计学意义(P<0.05),两组术后1mo水平彗差、垂直彗差及球差之间差异均无统计学意义(P>0.05); 两组术后3、6mo水平彗差、垂直彗差之间差异均无统计学意义(P>0.05),但飞秒激光制瓣LASIK术球差变化值小于角膜板层刀制瓣LASIK术,差异有统计学意义(P<0.05)。

结论：飞秒激光制瓣LASIK术是一种安全、有效、稳定的手术方式,干眼症发生率低,术后视觉质量更优于角膜板层刀制瓣LASIK。     

Phacoemulsification of the crystalline lens and implantation of an intraocular lens for the correction of moderate and high myopia: four-year follow-up

PURPOSE: To assess the safety of lens extraction and intraocular lens (IOL) implantation in patients with high myopia treated for initial lens opacity and/or refractive indications. SETTING: Instituto de Microcirugía Ocular de Barcelona, Barcelona, Spain. METHODS: This retrospective nonrandomized case series study comprised 44 eyes of 30 consecutive myopic patients who had surgery because of initial lens opacity and/or refractive indications during a 2-year period. In each case, phacoemulsification was performed using an ultrasonic technique and an IOL was implanted in the capsular bag. The patients were seen preoperatively to evaluate retinal pathology. They also had a complete ophthalmologic evaluation that included detailed indirect ophthalmoscopy. All patients were followed at regular intervals. The main outcome measures were preoperative and postoperative spherical equivalent (SE), the incidence of posterior capsule opacification (PCO) and the need for capsulotomy, and the incidence of retinal complications. RESULTS: In all eyes, the surgery was uneventful. The mean patient age at surgery was 42.83 years; the mean preoperative SE was -15.77 diopters (D) and the mean postoperative SE, -1.05 D. No eye required preoperative peripheral retinal photocoagulation. Twenty-five eyes (56.8%) had PCO and had a neodymium:YAG laser capsulotomy. One eye had a retinal tear 14 months after surgery and was treated with focal photocoagulation. The mean endothelial cell loss was 2.1% during the first postoperative year. Two eyes had an immediate postoperative intraocular pressure (IOP) rise, 1 with an inflammatory membrane and the other with corneal edema; both resolved with topical treatment. One eye with elevated IOP and a bad response to medical treatment had argon laser trabeculoplasty. No eye had a retinal detachment during the follow-up. CONCLUSION: With a thorough preoperative ophthalmologic evaluation and uneventful surgery, patients who have phacoemulsification and IOL implantation for the correction of myopia have a satisfactory chance of obtaining good visual results with few complications.     

Mitomycin C and excimer laser

Mitomycin C is an antimetabolite agent that blocks DNA and RNA replication and protein synthesis. It has been used in several ophthalmologic areas, and recently as a modulator of corneal wound healing in excimer laser surgeries. A single application of mitomycin C during surface corneal photoablative surgery seems a safe and efficient therapeutic option for eyes with corneal opacity and/or as prophylaxis in eyes with high risk for corneal opacity development. The use of this drug in photoablative surgery should be cautious until long-term safety results have been reported. The present text presents a review about corneal wound healing with the use of mitomycin C.     

Inadvertent perforation of the globe during regional anaesthesia

Purpose: This retrospective study was undertaken to review the clinical signs and management of patients with perforating eye injuries associated with regional anaesthesia for ophthalmic surgery.
Methods: Fifteen consecutive patients presenting with inadvertent perforation of the globe were evaluated. Eleven required vitreoretinal surgery. The indications were retinal detachment (six eyes), vitreous haemorrhage (four) and an epiretinal membrane (one eye).
Results: Those eyes with retinal detachments generally had a poor functional outcome in spite of the retinae being attached in five of the six eyes. The operative findings of those eyes with vitreous haemorrhage but attached retina demonstrated varying retinal tear configurations.
Conclusions: Eyes with perforating injuries following intraorbital anaesthesia are at risk of developing a retinal detachment. In those eyes presenting with dense vitreous but attached retina, consideration of vitrectomy and laser photocoagulation is advised.