Keeping retinal services up and running

In a special webinar organised by the UK and Ireland Society of Cataract and Refractive Surgeons (UKISCRS), Paul Rosen FRCS FRCOphth, Consultant Ophthalmic Surgeon at the Oxford Eye Hospital spoke about the impact the COVID-19 crisis is having on retinal services It is relatively calm at the moment. What has been interesting is the type of cases that we have seen recently, with very few macula-on retinal detachments and a higher number than usual of trauma cases. Two of them were due to people doing DIY at home and not using protective goggles. We expect that there will be a flurry of patients with macula-off detachments and proliferative vitreoretinopathy (PVR) that will come through when the restrictions are lifted. We have implemented case prioritisation in light of the restrictions on elective surgery. That means we are still dealing with any type of retinal detachment. We have, however, stopped doing macular hole repairs and epiretinal membrane peels for the time being, having managed to clear a lot of our more urgent cases before the restrictions came in. It would appear that a lot of patients are frightened to come to the hospital and that partly explains why it is so ‘calm’ at the moment, with a corresponding reduction in the number of patients coming to the Eye Emergency Department. I suspect that what will happen is that when the patients’ vision deteriorates and they go from macula-on to macula-off they will be more likely to come into casualty for treatment. We are treating all patients as though they were COVID-19 positive. As a result, we are wearing full personal protective equipment (PPE) with respirator type masks, hat, gown and double-gloving. We have deemed all intraocular surgery as an aerosol-generating procedure (AGP). There is a vapour plume generated by phacoemulsification, and likewise with the vitreous cutter. That prolongs the surgery by about 50% because of the additional precautions that we are taking pre- and post-surgery. For medical retina, intravitreal injections are still being administered for AMD, while diabetic retinopathy and retinal vein occlusion patients are being deferred. The COVID-19 crisis has forced us to adapt our systems and practices to the circumstances and that will give us ideas to improve our service in the post-COVID era. All of our junior staff have been taken away to help deal with general medical duties, on the wards and in the intensive care units. There is a lot of learning as the situation evolves, with the potential to modify our practices in enduring ways when the immediate pandemic is over.

Tags: covid-19 retina