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Mar 24, 2020

ASRS releases guidelines to help retina practices during COVID-19 pandemic

The American Society of Retina Specialists released guidelines to help retina practices and medical personnel reduce risk and assure the health and safety of patients during the COVID-19 pandemic.

The guidelines define essential visits for patients and provides a means to categorize emergent, urgent and non-urgent, non-elective cases during this period of limited operating room access, according to a release.

For emergent surgical indications, the risk of permanent vision loss without early intervention is high and access to operating room is vital. For urgent surgical indications, the risk of severe and permanent vision loss without immediate surgery is not as high and treatment can be delayed. Retinal surgeons should monitor urgent indications as they can become emergent, according to the ASRS press release.

For non-urgent, non-elective patients, surgery can be delayed without significant risk to further vision. Retinal surgeons should follow non-urgent, non-elective patients, as their condition can worsen and urgency increase.

The ASRS guidelines caution retina specialists to be judicious with their use of the emergent and urgent designations.

Examples of emergent surgical indications may include:

  • Acute retinal detachment – macula attached*
  • Acute retinal detachment – macula detached in a monocular patient*
  • Retained lens fragments with elevated intraocular pressure not controlled medically
  • Acute endophthalmitis with severe vision loss
  • Open globe injury with or without an intraocular foreign body*
  • Expulsive choroidal hemorrhage*
  • Dense vitreous hemorrhage in monocular patient
  • Exposed/infected scleral buckle or other ocular implant

(* May be urgent depending on location and character)

Examples of urgent surgical indications may include**:

  • Retinal detachment – macula detached
  • Retained lens fragment with medically controlled intraocular pressure
  • Vitreous hemorrhage in which a retinal tear or detachment is suspected

(** These indications could be considered emergent if the patient is monocular or extenuating circumstances arise.)

Examples of non-urgent, non-elective surgical indications may include***:

  • Macular hole
  • Dislocated intraocular implant lens
  • Diabetic vitreous hemorrhage with no macula-threatening retinal detachment
  • Retained silicone oil
  • Macular epiretinal membrane/Vitreomacular traction

(*** These indications could be considered urgent/emergent if the patient is monocular or extenuating circumstances arise.) 

Source: Healio

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