Author: Tatiana Imshenetskaya (Belarus)
Co-authors: Viktoriya Krasilnikova, Olga Yarmak, Galina Vashkevich, Vladimir Markevich, Robert Yermalkevich
Purpose
The optimal surgical approach in the treatment of rhegmatogenous retinal detachment during the period of the epidemic rise of COVID-19 should presuppose obtaining the maximum anatomical and functional result, which is possible only when performing a surgical operation by an experienced surgeon.
Setting/Venue
Indications for urgent surgery in patients with retinal detachment (RD) are: rhegmatogenous retinal detachment (RRD), tractional RD, RD with undetected retinal breaks, RD in the only seeing eye. RRD in patients with no light perception are not indicated for surgery in difficult epidemic situation. Purpose: to evaluate the management of RRD in patients have undergone surgical treatment on the basis of a non-ophtalmological department by surgeons of the Department of Ophthalmology of BelMAPE in "first wave" of COVID-19.
Methods
Main goals in management of RRD during “first wave” of COVID-19 were: 1) urgency of surgery; 2) protection during treatment to preserve doctor’s and patient’s health; 3) selection of operation room for surgery: "clean" ophthalmic operating room or operating room for patients infected with COVID-19; 4) selection of optimal surgical approach; 5) selection of surgeon - an experienced surgeon will shorten the surgery time and reduce the risks of intraoperative complications; 6) selection anesthethia type depends on patient's health status, including severity of patient's pneumonia associated with SARS COV-2, and recovery time. During the COVID-19 "first wave" (100 days), 52 surgeries were performed for RRD treatment.
Results
The final decision for RRD surgery indications was determined in each case individually. Our decision was based on RRD type (macula on, macula off), visual acuity of affected eye and general condition of the patient (age, comorbidity). Diagnosis and surgery were perfomed with the use of protective masks (for both the doctor and the patient), respirators, protective glasses and shields, maintaining physical distance. Direct ophthalmoscopy was excluded. Before surgery PCR test for COVID-19 was perfomed. Patients underwent following procedures: scleral buckling (SB) (88%), combined surgery (SB and pars plana vitrectomy (12%). There were 23% of surgeries that were perfomed after previous unsuccessful surgery of RRD, complicated with PVR. Anatomical and functional success were achieved in 90% of cases.
Conlusions
The optimal management of RRD during the COVID-19 epidemic period should have high rates of anatomical and functional success. We consider that it’s possible only when treatment perfomed by experienced surgeon.
Financial Disclosure
no financial interest
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