Rationale for American Society of Retina Specialists Best Practice Recommendations for Conducting Vitreoretinal Surgery During the Coronavirus Disease-19 Era
Restricted accessReview articleFirst published online October, 2020
Rationale for American Society of Retina Specialists Best Practice Recommendations for Conducting Vitreoretinal Surgery During the Coronavirus Disease-19 Era
This review details the rationale behind recommendations recently published by the American Society of Retina Specialists (ASRS) and outlines best practices for safety of vitreoretinal surgeons and staff while performing vitreoretinal surgery during the coronavirus disease 2019 (COVID-19) pandemic.
Methods:
The Committee for ASRS Best Practices for Retinal Surgery During the COVID-19 Pandemic reviewed existing evidence and information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and risk factors during vitreoretinal surgery. Recommendations were based on best available published data, cumulative clinical experiences, and recommendations and policies from other organizations. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the strength of recommendations and confidence in the evidence. These serve as interim recommendations that will be routinely updated given the current gaps of knowledge and lack of high-quality data on this evolving subject.
Results:
Relevant existing literature related to methods of transmission and ocular manifestations of SARS-CoV-2 are summarized. The data and clinical experiences driving recommendations for preoperative, intraoperative, and postoperative surgical considerations and anesthesia choice as well as considerations for intravitreal injections are provided.
Conclusions:
Recommendations are provided with the goal of protecting vitreoretinal surgeons and associated personnel from exposure to SARS-CoV-2 during interventional vitreoretinal procedures. This is a rapidly evolving topic with numerous remaining gaps in our current knowledge. As such, recommendations will evolve and the present article is intended to serve as a foundation for continued dialogue on best practices.
GuyattGHOxmanADVistGEKunzR. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–926. doi:10.1136/bmj.39489.470347.AD
4.
GuyattGHOxmanADKunzR, et al.GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol. 2011;64(4):395–400. doi:10.1016/j.jclinepi.2010.09.012
5.
AndrewsJCSchünemannHJOxmanAD, et al.GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol. 2013;66(7):726–735. doi:10.1016/j.jclinepi.2013.02.003
6.
RajgorDDLeeMHArchuletaSBagdasarianNQuekSC. The many estimates of the COVID-19 case fatality rate. Lancet Infect Dis. 2020;20(7):776–777. doi:10.1016/S1473-3099(20)30244-9
7.
VerityROkellLCDorigattiI, et al.Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669–677. doi:10.1016/S1473-3099(20)30243-7
8.
WilsonNKvalsvigABarnardLTBakerMG. Case-fatality risk estimates for COVID-19 calculated by using a lag time for fatality. Emerg Infect Dis. 2020;26(6):1339–1441. doi:10.3201/eid2606.200320
9.
WuPDuanFLuoC, et al.Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020;138(5):575–578. doi:10.1001/jamaophthalmol
10.
OnderGRezzaGBrusaferroS. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020;323(18):1775–1776. doi:10.1001/jama.2020.4683
11.
CDC COVID-19 Response Team. Characteristics of health care personnel with COVID-19—United States, February 12-April 9, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):477–481. doi:10.15585/mmwr.mm6915e6
LiQGuanXWuP, et al.Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199–1207. doi:10.1056/NEJMoa2001316
15.
AnfinrudPStadnytskyiVBaxCEBaxA. Visualizing speech-generated oral fluid droplets with laser light scattering. N Engl J Med. 2020;382(21):2061–2063. doi:10.1056/NEJMc2007800
16.
WölfelRCormanVMGuggemosW, et al.Virological assessment of hospitalized patients with COVID-2019. Nature. 2020;581:465–469. doi:10.1038/s41586-020-2196-x
17.
van DoremalenNBushmakerTMorrisDH, et al.Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564–1567. doi:10.1056/NEJMc2004973
18.
FearsACKlimstraWBDuprexP, et al.Comparative dynamic aerosol efficiencies of three emergent coronaviruses and the unusual persistence of SARS-CoV-2 in aerosol suspensions. MedRxiv. Preprint posted online April 18, 2020. doi:10.1101/2020.04.13.20063784
19.
GuoZDWangZYZhangSF, et al.Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg Infect Dis. 2020;26(7):1583–1591. doi:10.3201/eid2607.200885
Prather KA, Wang CC, Schooley RT. Reducing transmission of SARS-CoV-2. Science. 2020;368(6498):1422–1424. doi:10.1126/science.abc6197
22.
ChuDKAklEADudaSSoloKYaacoubSSchünemannHJ; COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020;(20)31142–31149. doi:10.1016/S0140-6736(20)31142-9
23.
ColavitaFLapaDCarlettiF, et al.SARS-CoV-2 isolation from ocular secretions of a patient with COVID-19 in Italy with prolonged viral RNA detection. Ann Intern Med. Published online April17, 2020. doi:10.7326/M20-1176
24.
LingliZXuZCastiglioneGMSoibermanUSEbergartCGDuhEJ. ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection. bioRxiv. Preprint posted online May 9, 2020. doi:10.1101/2020.05.09.086165
25.
HuiKPYCheungMCPereraRAPM, et al.Tropism, replication competence, and innate immune responses of the coronavirus SARS-CoV-2 in human respiratory tract and conjunctiva: an analysis in ex-vivo and in-vitro cultures. Lancet Respir Med. Published online May7, 2020. doi:10.2139/ssrn.3552870
26.
ChenLLiuMZhangZ, et al.Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol. 2020;104(6):748–751. doi:10.1136/bjophthalmol-2020-316304
27.
MarinhoPMMarcosAAARomanoACNascimentoHBelfortRJr. Retinal findings in patients with COVID-19. Lancet. 2020;95(10237):1610. doi:10.1016/S0140-6736(20)31014-X
28.
SeahIYJAndersonDEKangAEZ, et al.Assessing viral shedding and infectivity of tears in coronavirus disease 2019 (COVID-19) patients. Ophthalmology. 2020;127(7):977–979. doi:10.1016/j.ophtha.2020.03.026
29.
XiaJTongJLiuMShenYGuoD. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol. 2020;92(6):589–594. doi:10.1002/jmv.25725
LoonSCTeohSCOonLL, et al.The severe acute respiratory syndrome coronavirus in tears. Br J Ophthalmol. 2004;88(7):861–863. doi:10.1136/bjo.2003.035931
32.
PeirisJSMYuenKYOsterhausADMEStöhrK. The severe acute respiratory syndrome. N Engl J Med. 2003;349(25):2431–2441. doi:10.1056/NEJMra032498
33.
BaiYYaoLWeiT, et al.Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020;323(14):1406–1407. doi:10.1001/jama.2020.2565
34.
HeXLauEHYWuP, et al.Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020;26:672–675. doi:10.1038/s41591-020-0869-5
35.
LiRPeiSChenB, et al.Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). Science. 2020;368(6490):489–493. doi:10.1126/science.abb3221
36.
ZuZYJiangMDXuPP, et al.Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology. 2020;200490. doi:10.1148/radiol.2020200490
37.
GautierJFRavussinY. A new symptom of COVID-19: loss of taste and smell. Obesity (Silver Spring). 2020;28(5):848. doi:10.1002/oby.22809
38.
ZouLRuanFHuangM, et al.SARS-CoV-2 Viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177–1179. doi:10.1056/NEJMc2001737
39.
FauciASLaneHCRedfieldRR. Covid-19—navigating the uncharted. N Engl J Med. 2020;382(13):1268–1269. doi:10.1056/NEJMe2002387
40.
AhnESMillsDMMeyerDRStasiorGO. Sneezing reflex associated with intravenous sedation and periocular anesthetic injection. Am J Ophthalmol. 2008;146(1):31–35. doi:10.1016/j.ajo.2008.08.027
SchlagerA. Accumulation of carbon dioxide under ophthalmic drapes during eye surgery: a comparison of three different drapes. Anaesthesia. 1999;54(7):690–694. doi:10.1046/j.1365-2044.1999.00889.x
LiYWongTChungJ, et al.In vivo protective performance of N95 respirator and surgical facemask. Am J Ind Med. 2006;49(12):1056–1065. doi:10.1002/ajim.20395
46.
LiaoLXiaoWZhaoM, et al.Can N95 respirators be used after disinfection? And for how many times?ACS Nano. 2020;14(5):6348–6356. doi:10.1021/acsnano.0c03597
47.
LoebMMcGeerAHenryB, et al.SARS among critical care nurses, Toronto. Emerg Infect Dis. 2004;10(2):251–255. doi:10.3201/eid1002.030838
48.
MacIntyreCRChughtaiAARahmanB, et al.The efficacy of medical masks and respirators against respiratory infection in healthcare workers. Influenza Other Respir Viruses. 2017;11(6):511–517. doi:10.1111/irv.12474
49.
RadonovichLJJrSimberkoffMSBessesenMT, et al.N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA. 2019;322(9):824–833. doi:10.1001/jama.2019.11645
50.
LoebMDafoeNMahonyJ, et al.Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. JAMA. 2009;302(17):1865–1871. doi:10.1001/jama.2009.1466
MakSTYuenHK. Oculoplastic surgery practice during the COVID-19 novel coronavirus pandemic: experience sharing from Hong Kong. Orbit. 2020;39(4):316–318. doi:10.1080/01676830.2020.1754435
54.
ZhaoSLingKYanH, et al.Anesthetic management of patients with COVID 19 infections during emergency procedures. J Cardiothorac Vasc Anesth. 2020;34(5):1125–1131. doi:10.1053/j.jvca.2020.02.039
55.
HeYWeiJBianJ, et al.Chinese Society of Anesthesiology expert consensus on anesthetic management of cardiac surgical patients with suspected or confirmed coronavirus disease 2019. J Cardiothorac Vasc Anesth. 2020;34(6):1397–1401. doi:10.1053/j.jvca.2020.03.026
56.
ChiuPWYNgSCInoueH, et al.Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements). Gut. 2020;69(6):991–996. doi:10.1136/gutjnl-2020-321185
57.
TiLKAngLSFoongTWNgBSW. What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Can J Anaesth. 2020;67(6):756–758. doi:10.1007/s12630-020-01617-4
58.
KowalskiLPSanabriaARidgeJA, et al.COVID-19 pandemic: effects and evidence-based recommendations for otolaryngology and head and neck surgery practice. Head Neck. 2020;42(6):1259–1267. doi:10.1002/hed.26164
59.
PatelZMFernandez-MirandaJHwangPH, et al.Letter: precautions for endoscopic transnasal skull base surgery during the covid-19 pandemic. Neurosurgery. 2020;87(1):E66–E67. doi:10.1093/neuros/nyaa125
60.
YannuzziNASridharJFlynnHWJr, et al.Current trends in vitreoretinal anesthesia. Ophthalmol Retina. 2019;3(9):804–805. doi:10.1016/j.oret.2019.05.020
61.
LynchJBDavitkovPAndersonDJ, et al.Infectious Diseases Society of America Committee. Infectious Diseases Society of America Guidelines on Infection Prevention for Health Care Personnel Caring for Patients with Suspected or Known COVID-19. April 27, 2020. Updated April 30, 2020. Accessed July 14, 2020. https://www.idsociety.org/practice-guideline/covid-19-guideline-infection-prevention/
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
