REPORT: Retina Department of Ophthalmology Service, Valle de Hebron Hospital, Barcelona, Spain
Protocol covid-1. Retina Department of Ophthalmology Service, Valle de Hebron Hospital, Barcelona, Spain
Barcelona March 31, 2020
The priority of the Retina Department is the care of patients affected by URGENT and/ or NON-DEMORABLE pathology and to reduce the risk of contagion of patients, while preserving the health of the professionals who care for them.
- OUTPATIENT CLINIC:
– All NON-URGENT activity must be delayed.
– Whenever possible, telematic visit will be performed. Face-to-face visits will only be performed in the following cases: urgent visits and post-vitrectomy reviews 24h and 2 weeks after surgery, in case no incidents were detected in the immediate post-operative period.
– Patients will enter the visit by themselves. They may be accompanied by a maximum of one person in exceptional circumstances.
– Patients can only by accompanied by one person at the waiting room and must keep 1.5 meter distance between individuals.
– Accumulation of patients in the waiting room or at procedures must be avoided.
– All patients must wear surgical masks, and hydroalcohol gel dispensers will be placed in the waiting room.
– The ophthalmologist will wear a FFP2, gloves and protective glasses during the examination.
– The ophthalmologist will hand wash with soap and water or hydroalcoholic solution before and after each patient.
-The examination equipment before and after each patient will be cleaned with the antiseptic solutions usually used for disinfection.
– All patients and family must wash hands with hydroalcoholic gels at the entrance and exit of the consultation.
- TREATMENT WITH INTRAVITREAL INJECTIONS:
Only intravitreal injections which are considered urgent will be performed. Consequently, the profiles of each patient will be reviewed in the schedules and each one of them will be contacted by telephone contact to assess their state individually, taking into account the patient’s age and comorbidity. In addition, the patient will be asked about symptoms suggestive of COVID-19 infection, which would delay the injection. In case there’s any suspicion the patient might be infected by COVID-19 the ophthalmologist will contact him or her again in 2 weeks for reassessment.
Intravitreal therapy with intravitreal injections should be evaluated individually and will be restricted only to those patients who might have a harmful development in case of postponing the injection.
The patients that will be treated are the following:
– AMD in loading dose with initial VA ≧ 0.1 or single eyes in T&E regimens <6 weeks.
– Patients at risk of neovascular glaucoma for whom treatment with laser photocoagulation is to be postponed (see the section of laser treatment).
On the contrary, these cases will be postponed:
– AMD: advanced, in T&E regimen> 4 weeks, loading dose with initial VA <0.1, maintenance phase with fixed regimen and with more than two stable visits.
– Diabetic macular edema
– Macular edema secondary to retinal vein occlusions.
– Myopic neovascular membranes that have already received 1 dose of treatment and have not experienced subjective deterioration.
– Macular edema of another etiology (Irvine Gass), uveitis, etc
- LASER TREATMENTS:
The application of laser is limited to patients with retinal tears and/or holes with high-risk of suffering a rhegmatogenous retinal detachment.
Patients with high-risk of developing neovascular glaucoma secondary to a retinal vascular process will be individually assessed. In these cases, an urgent injection of anti-VEGF will be indicated and laser photocoagulation will be evaluated at 3-4 weeks.
All NON-URGENT retinal surgery is suspended and during this period the surgery will be limited to retinal detachment, endophthalmitis and ocular trauma (perforating wounds, intraocular foreign bodies…).
Surgeries with general anesthesia will be limited to those that are urgently necessary such as eye perforations.