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。     

新冠疫情期间眼病患者线上问诊模式与影响因素分析

目的：新型冠状病毒疫情期间,中山大学中山眼科中心在严格防控疫情的前提下及时开展免费线上“专家问诊”服务,眼科医师在线答疑以满足眼病诊疗需求。本研究对疫情期间眼科患者线上问诊的需求与模式进行分析,为眼科互联网诊疗体系的优化提供依据。

方法：前瞻性观察性研究。本研究分析了2020-02-01/03-15期间,使用中山眼科中心互联网医院“专家问诊”服务患者的基线特征。针对其中重复问诊的患者,随机抽取等量单次问诊患者作为对照,比较单次问诊与重复问诊患者的基线特征、就诊目的、疾病类型、眼病数量,并对患者问诊次数的影响因素进行分析。

结果：研究期间“专家问诊”共线上服务患者9 831人次,其中单次问诊3 919人次,5 912人次来源于1 967人的重复问诊。随机抽取1 967名单次问诊者与上述重复问诊者对比,单次问诊与重复问诊患者的年龄、性别分布无统计学差异(P=0.897, 0.482)。两组就诊目的均以“旧病复诊”占比最高(59.7%,64.9%)。从构成比上看,与单次问诊患者相比,重复问诊患者中,就诊目的为新发不适者较少,旧病复诊与术后复查者较多,眼表、眼底、葡萄膜疾病患者较多,患有两种及以上眼病者占比较多。回归分析显示屈光患者倾向单次问诊,而旧病复诊、术后短期复诊患者,眼底、葡萄膜疾病患者倾向重复问诊。旧病复诊、术后随访较新发不适患者重复问诊的次数更多; 晶状体与青光眼/疑似青光眼疾病重复问诊次数较少,眼表疾病重复问诊次数较多。

结论：疫情期间眼科患者线上就诊主要目的为旧病复诊。疾病种类、就诊目的与眼病数量均影响患者是否重复问诊及问诊次数,应根据患者的就诊需求与模式调整眼科不同亚专科线上接诊医生的数量与排班。互联网医疗对新发不适患者的诊疗能力有待进一步提高。     

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。     

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。     

中国干眼诊疗中心规范化建设专家共识(2021)

近年来干眼诊疗中心越来越受到我国眼科界的重视。干眼诊疗中心的建立有效地提高了干眼诊疗的效果,对于干眼的规范诊疗起到了积极的推动作用,深受广大医护人员及患者的欢迎。为促进干眼诊疗中心的持续、深入发展,各级医疗卫生机构可根据自身条件开展相应适宜技术为干眼患者提供个性化诊疗服务。但目前各级医疗卫生机构对于如何配备相应人员、药...     

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。     

利用眼科PACS系统管理青光眼患者

北京同仁医院的眼科“医学影像存档与传输系统”（picture archiving and communication system,PACS）-“眼科医院管理系统”将不同眼科检查设备联网,青光眼影像及报告永久存储,采用授权与密码保护相结合方式保护网络安全及患者隐私。医生在诊室通过院内网以及在院外互联网可实时查看、查询就诊过的患者目前与既往的影像检查及病历资料。患者通过互联网以“个人健康档案”的形式查看自己的病历与影像资料。这对青光眼患者诊治与随访尤其是作为慢病管理带来极大益处,为提高青光眼诊疗、教学与科研水平起到了促进作用。（眼科,2015,24： 61-63）     

小儿眼科与斜视学习班通知

由首都医科大学附属北京同仁医院眼科中心承办的国家级继续教育项目（编号：2010-07-02-119）——“小儿眼科与斜视学习班”将于2010年9月11-15日在北京举办。届时将邀请该领域的国内外知名专家作精彩讲演。小儿眼科与斜视学习班采用理论讲授、手术示教和专题讨论等形式进行学习交流，重点介绍小儿眼科与斜视领域规范化诊疗及新进展。内容包括：（1）儿童眼病诊疗进展（儿童眼底病、儿童眼表疾病、先天性青光眼、儿童眼整形的诊疗进展；屈光手术与儿童斜、弱视相关性的临床研究）；（2）婴幼儿视力筛查，弱视的规范化诊断和治疗；（3）斜视领域新进展（眼球运动与双眼视觉相关术语；     

新型冠状病毒肺炎疫情期间急诊眼外伤疾病谱特点及流行病学分析

目的 分析新型冠状病毒肺炎疫情期间眼科急诊眼外伤疾病谱变化趋势及流行病学特点。设计 回顾性比较性病例系列。研究对象 以2020年1月23日至3月31日北京同仁医院眼科急诊就诊的1209例眼外伤患者作为研究组,以2019年同期就诊的2444例眼外伤患者作为对照组。方法 通过医院信息系统调取数据,登记并整理患者的年龄、性别、就诊时间、眼外伤类别、致伤部位、就诊数量等情况,对眼外伤急诊疾病谱变化及流行病学特点进行分析。主要指标 年龄、性别、就诊时间、急诊诊断、患者数量。结果 疫情期间眼科急诊患者总数5978例,眼外伤患者1209例,占20.2%;2019年同期眼科急诊患者总数12776例,眼外伤患者2444例,占19.1%（χ2=3.111,P=0.078）。研究组男性患者835例（69.1%）,对照组男性患者1743例（71.3%）（χ2=1.976,P=0.160）。研究组患者年龄37.0（26.5,52.0）岁,对照组患者年龄35.0（22.0,50.0）岁（U=1369248.50,P＜0.001）。两组间各年龄组的就诊患者均以青年组（18~44岁）占比最高（研究组561例,46.4%;对照组1090例,44.6%）（χ2=1.062,P=0.303）;未成年组（0~17岁）患者就诊例数及比例的差异有统计学意义（研究组199例,16.5%;对照组548例,22.4%）（χ2=17.854,P＜0.001）。疫情期间非机械性眼外伤患者例数增多,其中电光性眼炎患者较去年同期明显增多（研究组141例,81.0%;对照组53例,46.9%）（χ2=36.437,P＜0.001）。机械性眼外伤患者较去年同期明显下降（研究组1035例,85.6%;对照组2331例,95.4%）（χ2=106.619,P＜0.001）。机械性眼外伤最常累及眼睑（研究组599例,57.9%;对照组1351例,58.0%）（χ2=0.002,P=0.964）;研究组的结膜损伤较对照组增多（研究组213例,20.6%;对照组336例,14.4%）（χ2=19.959,P＜0.001）;葡萄膜损伤较去年同期减少（研究组39例,3.8%;对照组131例,5.6%）（χ2=5.125,P=0.024）;开放性眼外伤所占比例的差异无统计学意义（研究组101例,9.8%;对照组193例,8.3%）（χ2=1.966,P=0.161）。结论 新型冠状病毒肺炎疫情期间眼科急诊总量及眼外伤急诊量明显下降。男性、青年、未成年人仍是急诊眼外伤的高发人群,未成年人发病率较去年同期下降。电光性眼炎患者明显增多,机械性眼外伤患者明显下降。     

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。     

新型冠状病毒肺炎疫情期间佩戴护目镜的正确选择和防雾指导

新型冠状病毒肺炎期间,为避免病毒感染,医护人员须做好各种有效防护,口罩、防护服和护目镜是必备的用具。多数医护人员佩戴护目镜期间镜片很快起雾,遮挡视线,严重干扰工作,导致护士不能有效治疗操作,医师不能精准诊疗,紧急时耽误患者抢救,防护不当甚至引发院内交叉感染。我们经过文献查询、临床实践结合专业知识,提出了如何正确选择护目镜,及解决护目镜防雾问题的七种方法。希望对抗疫的医护人员在新型冠状病毒肺炎防控中有所借鉴和帮助。     

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.     

Neuro-ophthalmic presentation of COVID-19 disease: A case report

COVID-19 is a respiratory virus, which has affected various organ systems as well. Here we report a neuro-ophthalmic presentation of pituitary apoplexy under the setting of COVID-19 infection in a middle-aged man who presented to ophthalmic emergency with sudden bilateral loss of vision along with a history of fever past 10 days. There was sluggishly reacting pupils and RT-PCR for COVID was positive. Imaging pointed the diagnosis as pituitary macroadenoma with apopexy. In view of pandemic situation, patient was given symptomatic treatment as per the protocols and stabilized. Vision also showed improvement to some extent and the patient is awaiting neurosurgery     

An analysis of the clinical profile of patients with uveitis following COVID-19 infection

Purpose:To describe the clinical profile of patients presenting with uveitis following COVID-19 infection at a tertiary care eye hospital in South India.Methods:In this retrospective chart review, all consecutive cases presenting with an acute episode of intraocular inflammation and a history of COVID-19 infection diagnosed within the preceding 6 weeks, between March 2020 and September 2021, were included. Data retrieved and analyzed included age, sex, laterality of uveitis, and site of inflammation. The diagnosis was categorized based on the SUN working group classification criteria for uveitis. Details regarding clinical features, investigations, ophthalmic treatment given, response to treatment, ocular complications, and status at last visit were also accessed. Statistical analysis of demographical data was done using Microsoft Excel 2019.Results:Twenty-one eyes of 13 patients were included in this hospital-based retrospective observational study. The study included six male and seven female patients. The mean age was 38 ± 16.8 years. Eight patients had bilateral involvement. Seven patients were diagnosed with anterior uveitis, three with intermediate uveitis, one with posterior uveitis, and two with panuveitis. All patients responded well to treatment and were doing well at their last visit. Two patients had complications that necessitated surgical treatment, following which they recovered good visual outcomes.Conclusion:With prompt diagnosis and appropriate management, all the patients with uveitis post-COVID-19 infection recovered with good visual outcomes. Thus, ophthalmologists must be aware of the possible uveitic manifestations following even uneventful COVID-19 infection.     

Stromal and endothelial herpes simplex virus keratitis reactivation in the convalescent period of COVID-19 – A case report

A 73-year-old lady presented with a white spot and redness in the left eye for 1 month and had been treated elsewhere as a case of fungal keratitis. She had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection 2 months before. Her past ocular history and examination gave a probable diagnosis of herpetic stromal and endothelial keratitis. She responded to oral acyclovir and topical steroid, leading to resolution of stromal edema and inflammation. Anterior chamber fluid polymerase chain reaction (PCR) confirmed pathogen herpes simplex virus (HSV)-1. HSV ocular reactivation after coronavirus disease 2019 (COVID-19) has been reported currently. The present report will add knowledge about this potential opportunistic ophthalmic infection during the recovery phase of COVID-19 disease.