LASIK procedures during COVID-19

During the COVID-19 pandemic, hospital systems and many medical practices have been affected by several changes of protocols. One of the most affected specialties is ophthalmology because of the potential to increase the COVID-19 transmission rate because of the close contact between patients and physicians.¹ At UltraLasik Eye Center in Dubai, we have tried to evaluate a Health, Safety, and Environmental (HSE) protocol for performing laser in situ keratomileusis procedures during the COVID-19 pandemic by following the staff at the center and 187 patients 4 weeks after having laser in situ keratomileusis.

This study was initiated after lockdown was partially lifted and approval for undertaking elective procedures was obtained from health authorities. The HSE protocol was divided into 3 phases: preoperative, perioperative, and postoperative. This prospective study was performed in May 2020 following Dubai Health Care City Authority HSE protocol.² A written consent form was obtained from all patients for use of medical data for research purposes, and an approval from the institutional review board at UltraLasik Eye Center was obtained. Duration of follow-up of 4 weeks was based on the study by Li et al. where the mean incubation period was 5.2 days (95% CI, 4.1-7.0), with the 95th percentile of distribution at 12.5 days.³

The preoperative phase started by taking the temperature of the patients, looking for symptoms such as cough or dyspnea, before they entered the center and by doing an intensive medical interview concerning any suspicious exposures or travels. If a patient had symptoms or a high temperature, their procedure was canceled or deferred. Social distancing was adopted by limiting the distance in the waiting room to 2 m between patients and by keeping a 20-minute interval between each patient admission. Furthermore, patients complied with hand hygiene using an alcohol-based solution, and all patients were monitored for constant wearing of surgical masks. The waiting room was cleaned in between patients’ visit with a bleach-based solution.

Perioperatively, the procedure was performed in a sterilized environment; staff wore an N95 mask, sterile gloves, and a disposable gown, and patients wore a surgical mask. After each procedure, the operating table and machine were cleaned with an alcohol-based solution. In addition, surgical hand scrubs were performed before and after each procedure. There were not any surgical complications during the procedures.

Postoperatively, 187 patients had follow-up visits at day 7, day 14, and day 28 for unusual symptoms such as new-onset conjunctivitis, cough, fever, or dyspnea. No patient developed any of those symptoms, and no patient was rejected during the full duration of this study. As for the staff of 7, no one tested COVID polymerase chain reaction positive before or after this study, and no one developed any of the aforementioned symptoms. The mean prevalence during May at UAE was around 1.96%.⁴ We were supposed to encounter a mean of 3.67 patients in our cohort testing positive and at risk to transmit the disease.

In conclusions, after following an HSE plan adapted to the American Academy of Ophthalmology, the American College of Surgeons, and U.S. Centers for Disease Control and Prevention recommendations and guidelines, it might be safe to do short outpatient elective procedures requiring topical anesthesia if all personal protective equipment are available.^5–7 However, in countries and regions where there is limited access to personal protective equipment, it is better to limit ophthalmologic procedures except emergent ones.