As ophthalmologists resume the full spectrum of surgical practice, in the era of pandemic, The American Academy of ophthalmology is offering guidance about how the COVID-19 pandemic will impact surgical decision-making, specifically around the indications for preoperative testing of patients and the use of personal protective equipment (PPE) by surgeon during surgical procedures. In general, the scientific basis to estimate the risk of SARS-CoV-2 infection during most ophthalmic surgical procedures is early and evolving, and the observations and guidance here will expand and change as the science progresses.

The role and interpretation of testing of patients prior to surgical procedures

SARS-CoV-2 RT-PCR positive

-COVID-19 can have lasting effects on respiratory function, if the surgery is elective, it may be better delayed for 6 weeks from the onset of symptoms

-When surgery on an RT-PCR positive patient is necessary due to the potential for permanent loss of vision or loss of life if delayed, the choice of anesthesia may be impacted by the patient’s overall medical condition

Serology positive

-Antibodies to SARS-CoV-2 generally become apparent in the first 7 to 14 days post-infection. A negative serologic test does not rule out active infection

-If IgM positive/IgG negative, the patient should be considered actively infected. If IgM and IgG are both positive, infection is recent and might still be active

-If IgM negative and IgG positive, the infection is in the past

Procedure-specific recommendations

CORNEA/REFRACTIVE

Corneal transplantation

-As of yet, there is no evidence for SARS-CoV-2 in the aqueous or vitreous humors. Corneal transplantation should not entail increased risk to the surgeon.

-Although any aerosol generated would be diluted by BSS in the irrigation, the risk of open-sky procedures that generate an aerosol is uncertain.

Ocular surface tumors and reconstruction

-The principle risk of aerosolization during ocular surface surgery would be during the use of cautery. Preoperative topical povidone-iodine as part of the surgical prep should inactivate any virus present in the tear film or on the ocular surface. 

-Topical povidone-iodine can be used during the surgery as long as the anterior chamber is not entered. Cautery should then be performed with vigorous irrigation, so that the BSS will dilute any plume. 

PEDIATRIC OPHTHALMOLOGY

Strabismus/muscle surgery:

-The major concern with strabismus surgery is associated with cautery

-5% povidone-iodine can cause corneal endothelial cell damage, if it enters the anterior chamber and should not be applied if there is an open surgical wound

Nasolacrimal duct surgery:

-Unless the patient has been tested and is RT-PCR negative for SARS-CoV-2, an N95 mask and face shield are recommended for the surgeon and operating room staff

These are the list of the key recommendations provided by The American Academy of ophthalmology to make your clinical practice stronger and easier. Though not in the frontline, ophthalmologists are helping mankind in surviving the pandemic risking their own health. We hope this guidance by The American Academy of ophthalmology will help you in your day to day practice.

Source: https://www.aao.org/headline/special-considerations-ophthalmic-surgery-during-c