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。     

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。     

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）     

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。     

医疗机构在感染性眼表疾病屈光检查中的感染控制

在临床工作中,眼科工作人员尤其是视光师在第一线面对感染性眼表疾病患者时,必须肩负起两个艰巨问题,即近视防控和感染防控的双重责任和压力。本文明确了眼科视光师在感染控制、屈光检查设备和场所消毒两个方面的实施细则,以进一步规范眼科屈光检查的临床操作流程,加强感染控制专业知识、方法与技能,降低被感染风险,避免交叉感染。汇总目前各大医疗机构的经验,从预防医学和眼科学角度,为眼科屈光检查时的感染控制提供全面且统一的建议意见。     

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。     

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.     

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。     

Impact of COVID-19 pandemic on ophthalmology medical student teaching: educational innovations,challenges, and future directions

Graduate medical education (GME) in ophthalmology has faced and overcome many challenges over the past years, and 2020 has been a game-changer. Although the severe acute respiratory syndrome coronavirus pandemic disrupted medical education globally, ophthalmic educators rapidly transformed their curricula to novel and effective virtual learning formats. Thus, while the COVID-19 outbreak has been one of the most significant challenges faced in the history of medical education, it has also provided an impetus to develop innovative teaching practices, bringing with it unprecedented success in allowing medical students to continue their education in ophthalmology despite these challenges. We review and appraise novel educational interventions implemented by various institutions in response to the COVID-19 pandemic, highlighting their effectiveness, challenges and proposing future directions beyond the pandemic. Many of these innovations will persist even after the end of the pandemic because they have proven that face-to-face learning is not required for all aspects of the ophthalmic GME curriculum. As ophthalmic educators harness the power of educational technology it is critical that their novel educational initiatives are incorporated into competency-based curricula with assessments mapped to the competencies. Future research should focus on evaluating the impact of this transformation to virtual learning environments on student performances as well as implementing longitudinal assessment strategies for clinical competence in workplace-based practice.     

Insights on the possibility of SARS-CoV-2 transmission through the eyes

A novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or 2019-nCOV), causing coronavirus disease 2019 (COVID-19), has rapidly spread to most countries and regions worldwide since it broke out at the end of 2019. Epidemic of the virus produces a tremendous pressure on the global health systems. With progressive insight into SARS-CoV-2, the role of eye tissue has attracted wide attention in the spread of COVID-19. Whether SARS-CoV-2 can enter the human body through eyes and cause infection? The fact that unprotected exposure of the eyes to 2019-nCoV might have allowed the virus to infect the body implies that 2019-nCOV can invade eye tissue and set foot in organism. Facing the severe challenge of preventing spread of the COVID-19, combined with the high-risk environment of ophthalmology, it is crucial to investigate ocular tropism of coronavirus. This paper explores the possibility of coronavirus transmission through the eye from aspects of probable mechanisms, clinical cases, detection of coronavirus; and puts forward precautions for ophthalmologists and nurses. Consequently, this review reveals our understanding of ocular tropism of coronavirus and contributes to determining risk of ocular transmission, raising awareness of necessary eye protection among medical workers and reducing further prevalence of SARS-CoV-2.     

AIDS眼部机会感染21例分析

目的:研究艾滋病眼部机会感染的临床特征。方法:观察在我院就诊的21例艾滋病合并眼部机会感染的患者。结果:21例患者中有14例(67%)为巨细胞病毒性视网膜炎(crtomegalovirusretinitis,CMVR)患者;21例患者中有19例(90%)患者的CD4<50/μL,20例(95%)的患者CD4<200/μL。结论:眼部机会感染常见于AIDS晚期,CMVR是AIDS患者常见的眼部机会性感染。     

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.     

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。