![]() ![]() On the morning of the surgery, the patient was again placed in a negative-pressure room in the preoperative area, and trained personnel helped us don and doff before were entered and after we exited the room. After extensive discussion with the perioperative staff, anesthesiologists and our surgical team, we developed a plan to keep all involved parties, including the ill patient, the other patients scheduled for eye surgery that day and all surgical staff, as safe as possible. As we soon learned, this was the first COVID-19-positive patient to have outpatient surgery at Harborview Medical Center. ![]() We planned the operation for a few days later, and we discovered the challenges and intricacies of scheduling a COVID-19 patient for outpatient surgery. ![]() pars plana vitrectomy, he elected to proceed with a PPV for the RD repair. After we had a complete discussion of pneumatic retinopexy vs. Given that this patient had a single superior retinal tear in a phakic eye, we offered him a pneumatic retinopexy while noting that this technique would mean he would need closer postoperative follow-up with possible later interventions such as laser, which could be challenging to coordinate because of his COVID-19 status. The patient was diagnosed with a macula-involving retinal detachment in the symptomatic eye. We quickly determined that a powered air-purifying respirator (PAPR) could not be used to carry out an indirect dilated fundus exam and that an N95 with a face mask was necessary.įortunately, our ED had well-trained personnel to help us don and doff protective gear so we could safely enter and exit the room to examine the patient. He did not require any supportive therapy for his respiratory symptoms. The test was positive and the patient was placed in a negative-pressure room for ophthalmic examination. The patient was first tested for COVID-19 using a reverse transcription polymerase chain reaction (RT-PCR) of a sample obtained by nasopharyngeal swab. In April, a middle-aged man with a history of recent mild respiratory symptoms and known exposure to family members positive for COVID-19 presented to the Harborview Medical Center emergency department with a gradual decrease in vision in one eye. Here we discuss the surgical evaluation and management of one of our practice’s first COVID-19-positive patients. Due to the nature of our specialty, many patients have eye conditions that require urgent care. While we attempted to limit potential interactions with COVID-19 positive patients in clinics, we were also responsible for seeing patients who came in through the emergency department with acute eye symptoms who needed to be managed with COVID-19 precautions. As ophthalmologists practicing in one of the first epicenters of the country, we quickly reduced the volume of clinic visits and restricted patient encounters to urgent and emergent visits to slow the spread of the virus and preserve resources. 3Īs retina specialists, we have a unique risk of exposure because we come into close face-to-face proximity with our patients, particularly during intravitreal injections, laser procedures and even basic slit lamp examinations. Patients with COVID-19 have complained of visual impairment, 2 with recent reports of subtle retinal findings without associated vision changes. Seattle rapidly became the country’s first hot spot and where the community transmission of the disease was first noted. On January 20, Washington state, where we practice, confirmed the first COVID-19 case in the United States. COVID-19 has had a profound impact on our practice as retina specialists.
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