German ophthalmologists must remain vigilant - EuroTimes

German ophthalmologists must remain vigilant

Gerd Auffarth MD, PhD

Gerd Auffarth MD, PhD, Professor and Chairman of The Department of Ophthalmology, Ruprecht-Karls University of Heidelberg; Director of the IVCRC and The David J Apple International Laboratory of Ocular Pathology at The University-Eye Clinic of Heidelberg spoke to EuroTimes Contributing Editor Dermot McGrath about the situation in his region.

“What we have done here in Heidelberg is to cancel all elective surgeries for the past two weeks. We have only been doing emergency surgery such as trauma cases, retinal detachments and so forth. We will still do corneal transplant surgery if we have the transplant material because otherwise the donor cornea will have to be discarded, which is something we prefer to avoid. But we are being kept busy here in our university clinic with two to three retinal detachments a day, as well as glaucoma patients with uncontrolled pressure and referred endophthalmitis cases.

We are one of the main hospital centres for the region and a lot of the smaller eye hospitals have stopped all surgeries and are referring their more serious cases on to us. The smaller practices have not been closed completely and can still see urgent cases such as red eye and minor injuries, which do not necessarily require surgery. This relieves the pressure somewhat on our services and makes sure that we are not overwhelmed and can deal with the real vision-threatening emergencies.

To protect our staff as much as possible, we have split our service into two distinct teams, which remain completely separate. When one team is on service, the other remains at home but in contact and then we switch every week.

Eye surgery on COVID-19 patients
We have some patients who have tested positive for COVID-19. We already did one retinal detachment surgery in one COVID-19 patient where we could not wait any longer without the risk of permanent vision loss. We have standard operating procedures for dealing with infectious patients, so it is not that different from operating on a patient with tuberculosis, for instance.

In fact, the eye doctors are not really the ones at most risk of infection during surgery as we completely seal the eye and have only a very small exposure area. It is the anaesthetists who are at the greater risk because they are working in proximity to the greatest viral load around the mouth and the throat. We opted in this particular case to do retrobulbar anaesthesia and just have the anaesthetist on standby in case it was not tolerated by the patient. This was complicated surgery with a total retinal detachment, but everything went well and we were able to send the patient home the following day.

For the moment, Heidelberg has quite a low rate of COVID-19 infections compared to some of the other regions in Germany.  But we have capacity for about 110 patients who may need ventilation, so the situation is under control for the moment. Of course, we have to remain vigilant because as we have seen elsewhere the number of cases can increase rapidly.

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