Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

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Purpose:  To determine the causes and frequency of orbital involvement by systemic disorders and non-ocular trauma at a tertiary Oculoplastic centre. Study Design:  Descriptive cross-sectional retrospective study. Ophthalmology unit Place and Duration of Study:  Department of Ophthalmology, Lady Reading Hospital Medical teaching Institute,  Peshawar from January 2012 and Dec 2016. Methods:  A total of 45 patients were included in this study. Patients’ demographics, clinical cause of orbitopathy and time delay between the problem noticed by the patient and presentation were recorded. Orbitopathy included the presence of corneal and conjunctival changes, optic nerve disorders, proptosis, orbital bone changes and soft tissue swelling of eyelids. The data was analyzed using SPSS software (version 22). The frequency (percentage) and mean ± standard deviation were reported for categorical variables. Results:  Mean age of the patients was 28.89 ± 22.02 years. There were 26 (57.8%) males 19 (42.2%) females. Commonest disorder was Bacterial Infection in 16 (35.6%) patients followed by Thyroid orbitopathy, which was seen in 14 (31.1%) cases. Other causes included Leukemia, Lymphoma, Retrobulbar Hemorrhage, Neurofibromatosis, Neuroblastoma, Maxillary Osteosarcoma, Teratoma and Fungal Infection. Time delay between presentation of orbital swelling and first noticed by patient was 147.02 ± 155.18 weeks in male while in female the time delay was 148.79 ± 146.47 weeks. Conclusion:  The commonest inflammation was due to thyroid, commonest infection was bacterial infection and commonest tumor was leukemia. Imaging and proper workup is important to properly treat any orbital disease. Key Words:  Orbit, Ocular trauma, Neuroblastoma, Orbital lymphoma.

Purpose:  To determine the demographic characteristics and causes of acquired, non-senile ptosis in patients presenting to an oculoplastic clinic of a tertiary care centre. Study Design:  Observational case series. Place and Duration of Study: Lady Reading Hospital, from January 2016 to December 2017. Methods:  Twenty eight patients were fulfilling the inclusion criteria were recruited in the study. Detailed history with complete examination and investigations like electromyography, acetylcholine receptor antibody test and CT/MRI brain were performed when required. Cause of each ptosis was determined and the relative proportions were calculated. Results:  There were 28 cases with acquired, non-senile ptosis. Fifty seven percent were males while females were 42.9%. Patients were divided into four age groups. Most of the patients were in age group of 42–62 years. Eyelid/orbit tumor and Chronic progressive external ophthalmoplegia (CPEO) was seen in 3.6% and 7.1% patients of < 20 years of age respectively. Myasthenia gravis and thyroid related pseudoptosis was common in patients of 21-41 years. In patients with age 42-62 years, Pseudoptosis due to thyroid disorder was the commonest. In patients with age more than 63 years, 3rd nerve palsy, eyelid/orbital mass and Myasthenia gravis was seen. Third nerve palsy and Pseudoptosis secondary to thyroid and eyelid/orbit mass were more common in males while Myasthenia gravis was more common in females. CPEO was equally seen in both genders with p = 0.575. Conclusion:  Thyroid related eyelid pseudoptosis of the contralateral eye was the commonest cause in this case series. Key Words:  Blepharoptosis, Third nerve palsy, Myasthenia gravis.