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。     

新型冠状病毒感染及其疫苗接种相关的眼科疾病

由新型冠状病毒(严重呼吸综合征-冠状病毒-2型,SARS-CoV-2)引起的新型冠状病毒肺炎(COVID-19),因其极高的传染致病性,严重威胁人类的生命健康,同时也给目前的医疗模式带来全新挑战。已有众多文献资料显示SARS-CoV-2感染不仅可以造成肺脏、肾脏、肠道等全身损害,而且也能累及眼组织,从较为常见的眼表疾病如角膜、结膜、巩膜炎症,到相对少见的旁中心急性中层黄斑病变和急性黄斑神经视网膜病变。对以眼部症状为首发或伴随症状的SARS-CoV-2感染患者而言,眼科医生如何甄别眼部表现与SARS-CoV-2感染之间的相关性无疑面临严峻的挑战。本文将结合近年相关文献,探讨由SARS-CoV-2感染和接种新型冠状病毒肺炎疫苗所引起的相关眼部病变,涵盖了眼表、葡萄膜、视网膜和黄斑以及颅神经等病理改变。     

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。     

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。     

我国医用眼防护装置的现状与需求

新型冠状病毒(SARS-CoV-2)肺炎造成全球性大流行,感染人数众多.医用眼防护装置技术的发展与管理对避免医务人员职业性眼暴露甚至感染至关重要.医用眼防护装置在技术上除了应满足防止患者体液及灌洗液飞溅,还应具备防雾、防紫外线辐射、防病原体眼部传播、防眼鼻周压力性损伤等功能;在管理上应优化应急消毒处置流程,增加重复使用...     

警惕冠状病毒经眼传播

目前新型冠状病毒肺炎(COVID-19)疫情在中国湖北武汉快速传播,并引起了国际社会的广泛关注。目前有线索认为结膜可能是新型冠状病毒(SARS-CoV-2)感染的入口之一。但目前缺乏SARS-CoV-2眼部感染的临床观察资料,因此了解冠状病毒经眼传播的机制和细胞受体,了解其他同源病毒感染眼部的传播特征,有助于眼科医生在COVID-19防控工作中采取合理防护措施并及时识别与眼部体征并存的COVID-19。     

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。     

充分认识COVID-19相关眼部损害, 努力提高诊疗水平

由严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)引起的新型冠状病毒感染(COVID-19)在全球持续大流行, 给全球医疗模式带来了深刻影响, 更多积累的、新的医学资料提示SARS-CoV-2感染会侵犯患者多个器官, 但对其引起的眼部相关病变特征及其危害仍缺乏足够认识。已有的临床资料发现, COVID-19相关眼病主要包括眼表炎性病变和眼后节的视网膜、脉络膜病变, 疾病不仅表现为急性炎性反应过程, 还可导致视网膜和脉络膜的微血管栓塞性病理过程, 给患者, 尤其是首诊为眼科的患者视力预后可能带来长期影响, 准确诊断COVID-19相关眼病是眼科医生面临的挑战。眼科医生应深入了解SARS-CoV-2感染者眼病相关疾病的发生机制和发展规律, 利用目前的眼科多模式影像检查以减少患者相关眼部疾病的漏诊和误诊, 及时采取针对性治疗措施, 尽可能降低疾病对视功能损害的风险。建议眼科临床工作者开展相关疾病的发病机制研究及多学科临床研究, 以降低COVID-19相关眼病患者的致盲率, 改善患者的生活质量。     

免疫抑制剂治疗对非感染性葡萄膜炎患者新型冠状病毒感染率及感染后果研究

有研究表明, 存在免疫功能障碍或使用免疫抑制剂治疗的患者, 感染新型冠状病毒(以下简称为新冠病毒)的风险增高且症状通常较普通人群更严重[1]。非感染性葡萄膜炎(NIU)常使用免疫抑制剂治疗, 包括系统性糖皮质激素(以下简称为激素)、传统免疫抑制剂和生物制剂。本研究初步探讨免疫抑制剂治疗是否增加NIU患者感染新冠病毒的风险, 是否延长感染后的病程及增加住院率, 以期为未来可能出现的再次新冠病毒及其他传染病流行提供NIU患者安全用药的参考。现将结果报道如下。     

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）     

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。     

Ophthalmic manifestations in the COVID-19 clinical spectrum

Purpose:The aim of this study was to determine the frequency and various types of ophthalmic manifestation of patients with COVID-19.Methods:This is a prospective observational study conducted on patients with SARS-Co-V-2 infection, at a dedicated tertiary COVID-19 hospital in South India from April 1 to July 31, 2020. At the time of their admission to the COVID hospital, demographic data such as name, age, sex was recorded. A thorough history regarding the onset, duration, progression, nature of symptoms and its associated factors, medication history, treatment history were elicited and documented. Ocular examination was performed under torchlight by an ophthalmologist posted for COVID duty. Further investigations including imaging were sought for, depending on clinical indications. Serial follow-up examinations of all patients were carried out every 72 hours or when patients complained of any ocular symptoms whichever earlier, until discharge. All relevant data were compiled and statistically analyzed.Results:A total of 2742 patients were examined. Of them, 1461 (53.28%) were males and 1281 (46.72%) were females. The mean age (±SD) was 39.46 ± 17.63 years. None of the patients in our study had any ocular symptoms or signs as the presenting complaint at the time of their admission. On subsequent follow-up, only 20 (0.72%) developed ocular manifestations, of which 19 (95%) had features suggestive of Bilateral viral conjunctivitis. However, 1 (5%) patient had orbital cellulitis secondary to pansinusitis.Conclusion:Ophthalmic manifestations in the clinical spectrum of COVID-19 infection are uncommon and unlikely to be the presenting clinical impression. However, it has broadened our view to a wider spectrum of COVID-19 presentations enhancing our clinical acumen for staunch detection of COVID-19 suspects in our daily practice, augmenting early diagnosis and management and also break the chain of transmission for the greater good of humanity.     

COVID-19 and Eye: A Review of Ophthalmic Manifestations of COVID-19

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had health implications of unprecedented magnitude. The infection can range from asymptomatic, mild to life threatening respiratory distress. It can affect almost every organ of the body. Ophthalmologists world over are reporting various manifestations of the infection in the eye. This review was undertaken to help ophthalmologists recognize the possible manifestations and the stage of the viral disease when they commonly appear. Literature search was performed for the publications on ophthalmic manifestations of coronavirus disease-19 (COVID-19) between January 1, 2020 and January 31, 2021. 46 case reports, 8 case series, 11 cross sectional/cohort observational studies, 5 prospective interventional studies, 3 animal models/autopsy studies and 6 reviews/meta-analysis were included. Conjunctivitis is the most common manifestation and can develop at any stage of the disease. Direct effect due to virus, immune mediated tissue damage, activation of the coagulation cascade and prothrombotic state induced by the viral infection, the associated comorbidities and drugs used in the management are responsible for the findings in the eye. The viral ribonucleic acid (RNA) has been isolated from ocular tissues but the role of eye as a route for infection is yet to be substantiated. Ophthalmic manifestations may be the presenting feature of COVID-19 infection or they may develop several weeks after recovery. Ophthalmologists should be aware of the possible associations of ocular diseases with SARS-CoV-2 in order to ask relevant history, look for specific signs, advise appropriate tests and thereby mitigate the spread of infection as well as diagnose and initiate early treatment for life and vision threatening complications.     

A case series of presumed fungal endogenous endophthalmitis in post COVID-19 patients

The novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, has challenged the medical community. Several ocular manifestations secondary to COVID-19 have been documented. Prolonged hospitalization exposes the patient to various multiresistant bacteria making them prone to various secondary infections. This case series describes four cases of presumed fungal endogenous endophthalmitis in patients who recovered from COVID-19.     

Scar sarcoidosis with systemic involvement after blepharoplasty

AIM: To explore the ocular features of COVID-19 and SARS-CoV-2 detection in tears and conjunctival scrapes in non-severe COVID-19 patients. METHODS: This is a multicenter observational clinical study with no intervention conducted from Jan 28th to March 1st 2020. Clinical data and samples of tears and conjunctival scraping were collected in consecutive laboratory-confirmed, non-severe COVID-19 patients from three hospitals. COVID-19 virus was analyzed by real-time RT-PCR kits. RESULTS: Totally 255 laboratory-confirmed, non-severe COVID-19 patients were recruited for ocular manifestation investigation. Of them, 54.9% were females, with a median age of 49.4y. None of the patients has evidence of uveitis, 11 patients (4.3%) complained of mild asthenopia, 2 (0.8%) had mild conjunctival congestion and serous secretion. Twenty-five of them had performed tears and conjunctival scrape for COVID-19 virus detection, with 4 yield possible positive results in the N gene. One of them were asymptomatic with normal chest CT and positive pharyngeal swab result. CONCLUSION: Ocular manifestations are neither common nor specific in non-severe COVID-19 patients. Meanwhile, COVID-19 virus nucleotides can be detected in the tears and conjunctival scrape samples, warranting further research on the transmissibility by the ocular route.     

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。     

Ocular manifestations and SARS-CoV-2 detection in tears and conjunctival scrape from non-severe COVID-19 patients

AIM: To investigate whether the axial length (AL)/total corneal refractive power (TCRP) ratio is a sensitive and simple factor that can be used for the early diagnosis of Marfan syndrome (MFS) in children. METHODS: The relationship between the AL/TCRP ratio and the diagnosis of MFS for 192 eyes in 97 children were determined. The biological characteristics, including age, sex, AL, and TCRP, were collected from medical records. Receiver operating characteristic (ROC) curve analysis was performed to investigate whether the AL/TCRP ratio effectively distinguishes MFS from other subjects. The Youden index was used to re-divide the whole population into two groups according to an AL/TCRP ratio of 0.59. RESULTS: Of 96 subjects evaluated, 56 (110 eyes) had a definite diagnosis of MFS in childhood based on the revised Ghent criteria, 41 (82 eyes) with diagnosis of congenital EL were included as a control group. AL was negatively correlated with TCRP, with a linear regression coefficient of -0.3566 (r=0.081). A significant correlation was found between age and the AL/TCRP ratio (P=0.023). ROC curve analysis showed that the AL/TCRP ratio distinguished MFS from the other subjects at a threshold of 0.59. MFS patients were present in 24/58 (41.38%) subjects with an AL/TCRP ratio of <0.6 and in 34/39 (87.18%) subjects with an AL/TCRP ratio of ≥0.6.CONCLUSIONS: An AL/TCRP ratio of ≥0.59 is significantly associated with the risk of MFS. The AL/TCRP ratio should be measured as a promising marker for the prognosis of children MFS. Changes in the AL/TCRP ratio should be monitored over time.