Propensity of aerosol and droplet creation during oculoplastic procedures: A risk assessment with high-speed imaging amidst COVID-19 pandemic.

PURPOSE: The study uses principles of liquid and gas mechanics to verify and quantify the generation of aerosols in oculoplastic procedures, namely surgery using a scalpel, electrosurgical device, and a mechanized drill. METHODS: Surgical techniques were performed ex vivo using the electrosurgical device, scalpel, and mechanized drill on the muscle and bone of commercially available chicken. The liquid and gas dynamics were observed using a high-speed high-resolution Photron SA5 camera (0.125 to 8 ms temporal resolution, 0.016 to 0.054 mm/pixel spatial resolution) and stroboscopic lighting (Veritas 120 E LED Constellation). The analysis was performed using in-house algorithms and ImageJ software. RESULTS: The use of a mechanized drill at 35000 rpm and a 3 mm fluted burr generated aerosol with particle size 50 to 550 microns with a spread of 1.8 m radius. Surgical smoke was generated by an electrosurgical device in both cutting and coagulation modes. Dispersion of the smoke could be controlled significantly by the use of suction, mean smoke spread ratio being 0.065 without suction and 0.002 with use of suction within 2 cm. CONCLUSION: The quantification of the aerosol generation will help surgeons take practical decisions in their surgical techniques in the pandemic era.

Resurgence of combined intravenous Ketamine and regional anesthesia in pediatric ocular surgery in COVID-19 pandemic.

PURPOSE: The current pandemic of COVID-19 has made airway procedures like intubation and extubation, potential sources of virus transmission among health care workers. The aim of this work was to study the safety profile of combined ketamine and regional anesthesia in pediatric ocular surgeries during the COVID-19 pandemic. METHODS: This prospective study included pediatric patients undergoing ocular surgery under general anesthesia from April to October 2020. Children were premedicated with oral midazolam (0.25-0.50 mg/kg) or intramuscular ketamine (7-10 mg/kg), ondensetron (0.1 mg/kg) and atropine (0.02 mg/kg). Anesthesia was achieved with intravenous ketamine (4-5 mg/kg) and local anesthesia (peribulbar block or local infiltration). The patient's vital signs were monitored. Serious complications and postoperative adverse reactions related to anesthesia were documented. RESULTS: A total of 55 children (62 eyes) were operated. Lid tear was the most common surgical procedure performed [n = 18 (32.7%)]. Dose of ketamine needed ranged from 30 to 120 mg (66.67 ± 30.45). No intubation or resuscitation was needed. Four children complained of nausea and two needed an additional dose of intravenous ondansetron due to vomiting in the post-operative period. Incidence of postoperative nausea and vomiting was not affected by age, duration of surgery or dose of ketamine used (P > 0.05). There was no correlation between increase in pulse and dose of ketamine. CONCLUSION: Combined ketamine and regional anesthesia is a safe and effective alternative to administer anesthesia in a child during ocular surgeries.

Urgent safety considerations for dermatologic surgeons in the COVID-19 pandemic.

Dermatologic surgeons are at increased risk of contracting SARS-COV-2. At time of writing, there is no published standard for the role of pre-operative testing or the use of smoke evacuators, and personal protective equipment (PPE) in dermatologic surgery. Risks and safety measures in otolaryngology, plastic surgery, and ophthalmology are discussed. In Mohs surgery, cases involving nasal or oral mucosa are highest risk for SARS-COV-2 transmission; pre-operative testing and N95 masks should be urgently prioritized for these cases. Other key safety recommendations include strict control of patient droplets and expanded pre-clinic screening. Dermatologic surgeons are encouraged to advocate for appropriate pre-operative tests, smoke evacuators, and PPE. Future directions would include national consensus guidelines with continued refinement of safety protocols.

Implementation of Novel Protocols in an Ophthalmic Ambulatory Surgical Center to Resume Surgical Procedures During COVID-19.

BACKGROUND AND OBJECTIVES: With the resumption of elective ophthalmic surgery during COVID-19, revised protocols were mandated to protect both staff and patients from transmission while increasing case numbers. We discuss a widely generalizable and in-depth protocol intended to safely allow the restart of elective procedures in 2 dedicated ophthalmic ambulatory surgical centers (ASCs) using monitored anesthesia care. METHODS: A single-center review of protocols and practices designed to limit COVID-19 transmission. RESULTS: All patients were tested within 72 hours prior to the procedure with a COVID-19 nasal swab to assess for active disease. A distance of 6 ft between each stretcher and the staff within the ASC was maintained when possible. Preoperative anesthetizing and dilating eye drops were administered from multiuse bottles without contact with surfaces. Surgical cases were restarted at a reduced capacity of a maximum of 7 per day to distance patient arrivals. Removal of waiting room chairs and the creation of new break areas allowed for social distancing. CONCLUSION: As recommendations change on the basis of an increased understanding of the COVID-19 virus, ophthalmologists and ASC staff need to tailor protocols and workflows to limit transmission of virus with resumption of ocular surgery.

Emergent Ophthalmic Surgical Care at a Tertiary Referral Center During the COVID-19 Pandemic.

PURPOSE: This study characterized the delivery of emergent ophthalmic surgical care during April 2020 of the coronarvirus disease-19 (COVID-19) pandemic compared with the same interval the previous year. DESIGN: Retrospective observational before-and-after study. METHODS: This study reviewed and characterized each emergent and/or urgent procedure performed during April 2020 and April 2019 at a single tertiary ophthalmology referral center. Information collected included the details of patient presentation, diagnosis, surgical procedure, and preoperative COVID-19 testing. RESULTS: In total, 117 surgical procedures were performed on 114 patients during the month of April 2020 compared with 1,107 performed in April 2019 (P < .0001). Retinal detachment repair was the most common procedure (n = 37; 31.6%) in April 2020, whereas elective cataract surgery (n = 481; 47.3%) was the most common procedure in April 2019. The mean age of patients was 50.0 years in April 2020 compared with 59.0 years (P < .0001) the previous year. During April 2020, the mean age of surgeons performing procedures was 42.3 years compared with 48.4 years (P < .0001) during April 2019. In April 2020, all but 5 patients (96%) had reverse transcriptase polymerase chain reaction based COVID-19 testing before their procedure. One patient (0.88%) had a positive COVID-19 test. CONCLUSIONS: The COVID-19 pandemic decreased our institution's surgical volume in April 2020 to approximately 10% of the usual volume. The pandemic changed the type of cases performed and led to a statistically significant decrease in both the age of our surgeons and patients relative to the same interval in the previous year. Broad preoperative screening led to 1 positive COVID-19 test in an asymptomatic patient.

Oculoplastic surgery practice during the COVID-19 novel coronavirus pandemic: experience sharing from Hong Kong.

At present, all parts of the world are hit hard by COVID-19. The first confirmed case of COVID-19 in the territory of Hong Kong was announced on January 23, 2020. Since then, oculoplastic surgeons in Hong Kong have been taking every measure to protect all healthcare workers and patients from contracting the disease. This paper aims to share the experiences of and measures taken by local oculoplastic surgeons in combating COVID-19. Three main aspects are discussed, namely clinical, administrative, and training and educational. We hope our experiences would provide reference to fellow oculoplastic colleagues in other parts of the world in fighting this COVID-19 pandemic.