REPORT: Department of Ophthalmology, University Of Bonn, Germany

Frank G. Holz

COVID-19 pandemic – Changes in patient care

We have cancelled all elective surgeries and outpatient visits and are operating emergency cases only such as retinal detachments, trauma, endophthalmitis and so forth.

We are contacting patients before they come into the hospital and have put in place a triage system to ensure that priority cases are dealt with efficiently while limiting the risk of exposure for patients and staff.

Protective measures
– We are following all of the usual guidelines that have been issued by national health authorities around Europe to protect health personnel and patients and to limit disease transmission.
– This includes all the usual measures in terms of sanitary protocols, protective clothing, appropriate distancing measures etc.

Intravitreal injections
– We do not consider intravitreal injections as an elective procedure because we have known for many years that if the therapy is not delivered in the appropriate time-frame that the patients have a high risk of irreversible vision loss.
– So there is no question of delaying intravitreal injections indefinitely until the pandemic is over as this would be to the detriment of our patients’ vision and quality of life in the long run.
– We continue to administer intravitreal injections, but with much tighter controls in terms of visitors or family members accompanying patients to the clinic as well as the use of protective masks, gloves, and gowns for the physician.
– We have carefully spaced out the visits to the hospital and minimised the use of any diagnostic examination.
– If the patient has no complaint of worsening vision, we do not check visual acuity, nor do we perform a slit-lamp examination, funduscopy or OCT imaging.
– We keep them on a simple injection schedule, so if they were receiving an injection every month, then that is maintained. For all other patients we chose a two months interval in the hope that things will return to normal before long. In any case we advise self-monitoring by the patients.
– Neovascular AMD is probably the most demanding disease entity in terms of the scheduling whereas we have learned that diabetic macular oedema (DME) after the first year may be more forgiving. Patients with retinal vein occlusion (RVO) are more of a mixed bag, with some requiring intensive treatment, while others have less need for regular injections. Overall, we feel with these precautions that we can balance risk and benefit.
– Of course, once this current crisis has passed, we will be faced with a huge backlog of elective surgeries and outpatient visits which will need to be managed. It is not ideal but there is no alternative in the current circumstances.

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