Abstract
We greatly appreciate the interest that Drs Yeoh, Yong, and Husni have demonstrated in our recent paper.1,2 The authors present data that enhance our knowledge on how ophthalmic surgery management strategies are implemented in a Malaysia tertiary eye care center. We agree that proper screening measures are pivotal to prevent the spread of the virus and to minimize COVID-19 hospital outbreaks. Preoperative screening for COVID-19 is intended to preserve safety for both patients and surgical teams. Due to the high level of the virus in the upper respiratory tract even two to three days prior to the onset of symptoms, asymptomatic or presymptomatic persons with COVID-19 are capable of transmitting the virus to others. For this reason, we believe that an assessment of patient symptoms is inadequate as the only method of screening and patient history must be screened for potential sources of exposure to SARS-COV-2. To appropriately integrate testing for SARS-CoV-2 infection into preoperative surgical triage, the temporal dynamics of the viral infection must be considered. The incubation period of SARS-CoV-2 has been estimated to be approximately four to five days. The virus is infectious both before and after the onset of symptoms. At the time of this publication, the reverse transcriptase-polymerase chain reaction (RT-PCR) test is considered the gold standard diagnostic test for SARS-CoV-2 infection and should thereafter be performed in all surgical cases. When resources are limited, RT-PCR test should be obtained at least in patients requiring hospitalization. Drs Yeah, Yong, and Husni report that chest X-ray were done in their institution for all cases as a screening measure of COVID-19. 1 We do not adopt this approach as we believe that thoracic imaging is helpful in characterizing the extent of pulmonary involvement from COVID-19, rather than providing a method of screening SARS-CoV-2 infection. 3
An aspect that remains controversial is the management of urgent cases such as open-globe injuries which often require surgical repair before the results of RT-PCR are available. In our department we immediately proceed to the operating theatre when surgery cannot be deferred. In those cases, patients are considered positive until proven otherwise. Protocolized clearly defined pathways are available to healthcare professionals caring for these patients. These well-established plans include instructions for patient transport, operating room preparation, personal dressing, environment sanitization, and waste disposal.
In conclusion, surgical decision-making should integrate the urgency of the patient's condition, the temporal dynamics of SARS-CoV-2 infection, and local availability of resources.
