Online March 24, 2020
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The American Academy of Ophthalmology has released recommendations regarding urgent and nonurgent patient care. According to the statement, all ophthalmologists should cease providing any treatment other than urgent or emergent care immediately. This includes both office-based care and surgical care. For specific procedures, see table below.
List of Urgent/Emergent Ophthalmic Surgeries
March 27, 2020
Surgical Procedure |
Indications |
Biopsy of orbit
|
Suspected intraocular malignancy or immediate sight-threatening condition |
Biopsy of temporal artery
|
Suspected giant cell arteritis
|
Brachytherapy
|
Intraocular malignancy
|
Cantholysis
|
Sight-threatening conditions
|
Canthotomy
|
Sight-threatening conditions
|
Cataract surgery
|
Congenital cataract in the amblyopic period, monocular patients with documented vision loss precluding driving, reading or self-care, lens-induced glaucoma, angle-closure glaucoma, acute lens complications, or severe anisometropia of fellow eye post recent lens extraction in first eye
|
Closure of cyclodialysis cleft
|
Sight-threatening hypotony due to trauma
|
Corneal transplantation
|
Pediatric patients with corneal blindness in both eyes in their amblyopic period
|
Decompression of dacryocele
|
Neonate with obstructive respiratory compromise
|
Decompression of orbit
|
Orbital tumor with impending vision loss
|
Drainage of abscess
|
Orbital cellulitis
|
Drainage of choroidals
|
Appositional choroidal effusion, suprachoroidal hemorrhage, or flat anterior chamber
|
Enucleation
|
Ocular trauma, infection, intractable glaucoma, globe perforation, intractable pain, or intraocular malignancy
|
Evisceration
|
Sight-threatening infection, or intractable pain
|
Examination under anesthesia
|
Pediatric patients with retinoblastoma, endophthalmitis, Coats Disease, uveitis, glaucoma, ocular trauma, retinal detachment, or presumed intraocular foreign body
|
Excision of tumors
|
Malignancy or sight-threatening tumor
|
Exenteration
|
Life-threatening infection
|
Exploration of orbit
|
Life-threatening or sight-threatening conditions
|
Fenestration of optic nerve sheath
|
Progressive vision loss
|
Filtration surgery
|
Uncontrolled intraocular pressure that is sight-threatening who are poor candidates for trabeculectomy or aqueous tube shunts
|
Frontalis sling
|
Sight-threatening congenital ptosis
|
Goniotomy ab externo or ab interno
|
Uncontrolled intraocular pressure that is sight-threatening
|
Insertion of drainage implant with or without graft
|
Catastrophic or rapidly progressive glaucoma
|
Laser indirect retinopexy – complex
|
Retinal detachment, retinal tear, or ocular trauma
|
Laser photocoagulation
|
Pediatric patients with retinopathy of prematurity (if this can’t be in NICU)
|
Pars plana lensectomy
|
Acute lens complications
|
Peeling of membrane/internal limiting membrane
|
Proliferative diabetic retinopathy, proliferative vitreoretinopathy, complex preretinal membrane, complex macular pathology, or macular hole
|
Pneumatic retinopexy
|
Retinal detachment
|
Probing of nasolacrimal duct
|
Dacryocystocele
|
Reconstruction of ocular surface or other tectonic procedures
|
Acute chemical injury, or acute Stevens Johnson Syndrome
|
Removal of aqueous drainage implant
|
Endophthalmitis, corneal touch, corneal decompensation, or exposed plate
|
Removal of intraocular foreign body
|
Presumed intraocular foreign body
|
Repair of anterior segment or cornea
|
Lacerations, blunt rupture, or deeply embedded corneal foreign body
|
Repair of canalicular laceration
|
Injury or trauma to their canaliculus
|
Repair of dehiscence of corneal graft or other anterior segment wound
|
Wound dehiscence or other wounds, including dislocated LASIK flaps
|
Repair of extrusion or complication of keratoprosthesis
|
Complications with implanted devices in their cornea or anterior segment
|
Repair of eyelid/face
|
Lacerations of eyelid or face
|
Repair of facial fractures
|
Displaced facial bone fractures
|
Repair of open globe
|
Ocular trauma
|
Repair of operative wound(s)
|
Bleb leaks, wound leaks, overfiltration, underfiltration, bleb scarring, sight-threatening hypotony, or shallow anterior chamber
|
Repair of orbital fracture
|
Hemodynamic instability or oculocardiac reflex
|
Repair of perforation or impending perforation of cornea or sclera
|
Corneal and scleral injury or trauma
|
Retrobulbar injection
|
Pain due to ocular diseases causing significant compromise of quality of life
|
Revision of drainage implant with or without graft
|
Implant/tube exposure that might be sight threatening, endophthalmitis, malpositioned tube endangering eye or excessive inflammation, a tube that might worsen vision due to corneal edema or iritis or cystoid macular edema, or with a severe tube malposition causing rapid visual loss
|
Scleral buckle
|
Retinal detachment, ocular trauma, intraocular infection, vitreous hemorrhage, retinal tear, or intraocular foreign body
|
Synechiolysis
|
Lens-induced glaucoma or angle-closure glaucoma
|
Tarsorrhaphy
|
Impending corneal compromise
|
Trabeculectomy with or without scarring
|
Catastrophic or rapidly progressive glaucoma and markedly elevated intraocular pressure, or uncontrolled secondary or primary glaucoma
|
Trabeculotomy
|
Uncontrolled intraocular pressure that is sight-threatening
|
Transscleral cyclophotocoagulation
|
Uncontrolled glaucoma or absolute glaucoma with a blind and painful eye
|
Vitrectomy
|
Retinal detachment, ocular trauma, intraocular infection, vitreous hemorrhage, retinal tear, intraocular foreign body, misdirected aqueous, ciliary block glaucoma, malignant glaucoma, a vitreous prolapse, or a tube shunt that blocks filtration
|
Washout of the anterior chamber
|
Hyphema that is sight-threatening
|