Napoli Pietro Emanuele, Nioi Matteo, d'Aloja Ernesto, Fossarello Maurizio
Department of Surgical Science, University of Cagliari, Eye Clinic, via Ospedale 46, 09124 Cagliari, Italy.
Department of Clinical Sciences and Public Health, University of Cagliari, Forensic Medicine Unit, 09124 Cagliari, Italy.
J Clin Med. 2020 May 9;9(5):1403. doi: 10.3390/jcm9051403.
Ocular surgery is one of the most performed medical procedures in the world. Its limitation or suspension, recursively extended over time, could be associated with a significant increase in the number of blind people worldwide. Indeed, cataract causes more than half of all cases of visual impairment in those countries with limited availability of means for performing eye operations (e.g., Africa or India). In this scenario, the pandemic of coronavirus disease 2019 (COVID-19) quickly resulted in the suspension or sharp reduction of various ophthalmic activities considered non-urgent, including lens replacement surgery or some intraocular injections. Despite the imperative need to continuously practice eye operations to avoid the abovementioned problems, there are currently little-shared and vague recommendations among the various countries on safety in operating rooms (for health care workers and patients) and poor legal protection for surgeons (potentially transmitting the COVID-19 infectious agent). Herein, we individuated and discussed some critical points in safety recommendations and medical liability. A paradigm shift for ocular surgery during the COVID-19 era is now mandatory. While telemedicine has been able to solve some problems in clinical ophthalmology, the lack of adequate health and legal protection for surgeons and patients may result in an excessive reduction in the volume of surgical interventions during a pandemic era and the immediately following period, thus determining inability to ensure health care to all patients.
眼科手术是世界上实施最为频繁的医疗程序之一。随着时间的推移，其限制或暂停不断延续，可能会导致全球盲人数量大幅增加。事实上，在那些实施眼科手术手段有限的国家（如非洲或印度），白内障导致的视力损害病例占所有病例的一半以上。在这种情况下，2019年冠状病毒病（COVID-19）大流行迅速导致各种被认为非紧急的眼科活动暂停或大幅减少，包括晶状体置换手术或一些眼内注射。尽管迫切需要持续开展眼科手术以避免上述问题，但目前各国在手术室安全（针对医护人员和患者）方面的建议几乎没有共享且含糊不清，外科医生的法律保护也很薄弱（可能传播COVID-19传染源）。在此，我们确定并讨论了安全建议和医疗责任中的一些关键点。COVID-19时代眼科手术的范式转变现在势在必行。虽然远程医疗能够解决临床眼科的一些问题，但外科医生和患者缺乏足够的健康和法律保护，可能会导致大流行期间及之后立即出现手术干预量过度减少的情况，从而无法确保为所有患者提供医疗服务。
