Daniel L Chao1, Jayanth Sridhar2, Ajay E Kuriyan3, Theodore Leng4, Brad P Barnett5, Aaron F Carlin6, Charles C Wykoff7, Stephen Gayer8, Prithvi Mruthyunjaya4, Yoshihiro Yonekawa3, Amani A Fawzi9, Audina M Berrocal2, Steven Yeh10, Daniel Ting11, Yasha Modi12, David N Zacks13, Nicholas Yannuzzi2, Natalie A Afshari1, Timothy Murray14. 1. Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego La Jolla, CA. 2. Bascom Palmer Eye Institute, University of Miami, Miami FL. 3. Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA. 4. Byers Eye Institute at Stanford, Department of Ophthalmology, Stanford University, Palo Alto, CA. 5. Duke Eye Center, Department of Ophthalmology, Duke University, Durham, NC. 6. Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego (UCSD), La Jolla, CA. 7. Retina Consultants of Houston, Retina Consultants of America; Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, Texas. 8. Department of Anesthesia, University of Miami, Miami FL. 9. Department of Ophthalmology, Northwestern University, Chicago IL. 10. Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, GA. 11. Singapore National Eye Center, Singapore, Singapore. 12. Department of Ophthalmology, New York University, New York, NY. 13. Kellogg Eye Center, Department of Ophthalmology, University of Michigan, Ann Arbor, MI. 14. Murray Ocular Oncology and Retina, Miami FL.
Abstract
PURPOSE: To detail the rationale behind recommendations recently published by the American Society of Retina Specialists (ASRS) outlining best practices for safety of vitreoretinal surgeons and staff while performing vitreoretinal surgery during the coronavirus disease (COVID)-19 pandemic. METHODS: The committee for ASRS Best Practices for Retinal Surgery during the COVID-19 Pandemic reviewed existing evidence and information on 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 (GRADE) approach was used to assess the strength of recommendations and confidence in the evidence. These serve as interim recommendations which are routinely updated given 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 pre-operative, intraoperative and post-operative surgical considerations, anesthesia choice, as well as considerations for intravitreal injections are provided. CONCLUSION: 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 current manuscript is intended to serve as a foundation for continued dialogue on best practices.
PURPOSE: To detail the rationale behind recommendations recently published by the American Society of Retina Specialists (ASRS) outlining best practices for safety of vitreoretinal surgeons and staff while performing vitreoretinal surgery during the coronavirus disease (COVID)-19 pandemic. METHODS: The committee for ASRS Best Practices for Retinal Surgery during the COVID-19 Pandemic reviewed existing evidence and information on 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 (GRADE) approach was used to assess the strength of recommendations and confidence in the evidence. These serve as interim recommendations which are routinely updated given 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 pre-operative, intraoperative and post-operative surgical considerations, anesthesia choice, as well as considerations for intravitreal injections are provided. CONCLUSION: 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 current manuscript is intended to serve as a foundation for continued dialogue on best practices.
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