The Coronavirus Disease 2019 , caused by severe acute respiratory coronavirus-2, was first reported in December 2019. The World Health Organization declared COVID-19 a pandemic on March 11, 2020 and as of April 17, 2020, 210 countries are affected with >2,000,000 infected and 140,000 deaths. The estimated case fatality rate is around 6.7%. We need to step up our infection control measures immediately or else it may be too late to contain or control the spread of COVID-19. In case of local outbreaks, the risk of infection to healthcare workers and patients is high. Ophthalmic practice carries some unique risks and therefore high vigilance and special precautions are needed. We share our protocols and experiences in the prevention of infection in the current COVID-19 outbreak and the previous severe acute respiratory syndrome epidemic in Hong Kong. We also endeavor to answer the key frequently asked questions in areas of the coronaviruses, COVID-19, disease transmission, personal protection, mask selection, and special measures in ophthalmic practices. COVID-19 is highly infectious and could be life-threatening. Using our protocol and measures, we have achieved zero infection in our ophthalmic practices in Hong Kong and China. Preventing spread of COVID-19 is possible and achievable.
We would like to commend Vock et al., 1 whose study demonstrated that primary posterior continuous curvilinear capsulorhexis (PCCC) could significantly reduce posterior capsule opacification (PCO) in routine cataract surgery. Although in our center it is not routine practice to perform PCCC in adult cataract cases, we are impressed by the low PCO and neodymium:YAG (Nd:YAG) laser capsulotomy rates reported in the study. However, we would be grateful if the authors would elaborate on a few issues concerning the effects of primary PCCC.A similar study by the same group of investigators was published in 2003. 2 In that study, surgery was performed by the same experienced surgeon using similar surgical techniques, hydrophilic intraocular lens (IOL), and image analysis methods. However, the outcome was significantly less favorable than that in the present study. Lens epithelial cell (LEC) migration occurred in 79% of eyes, causing PCCC ongrowth and closure in 55% and 7%, respectively. In the present study, PCCC ongrowth and closure rates were as low as 6.5% and 0%, respectively. We noticed that the types of IOLs were different in the 2 studies. Hydrophilic hydrogel IOLs with round optic edges were used in the previous study, but hydrophilic acrylic IOLs with sharp posterior optic edges were used in the present one. This may be a significant confounding factor accounting for the low PCO rate in the present study since the barrier effect of a sharp optic edge on LEC migration and hence prevention of PCO has been established by several earlier studies. 3,4 We believe the use of a control group without PCCC may make the clinical effects of primary PCCC on PCO prevention more conclusive.We hope the authors can also provide more information on the profile of intraoperative complications, such as vitreous disruption or herniation, and postoperative complications, such as retinal detachment (RD) or cystoid macular edema (CME), which have been shown to be more common if the posterior capsule is breached. 5 We believe this information will help us formulate a working risk-to-benefit ratio for performing primary PCCC in routine adult cataract surgeries.For a long time, PCO has been a major unresolved issue in cataract surgery. We commend and look forward to the authors' continuous efforts in investigating methods of preventing PCO. REFERENCES 1. Vock L, Menapace R, Stifter E, et al. Clinical effects of primary posterior continuous curvilinear capsulorhexis in eyes with single-piece hydrophilic acrylic intraocular lenses with and without haptic angulation. J Cataract Refract Surg 2007; 33: 258-264 2. Georgopoulos M, Menapace R, Findl O, et al. After-cataract in adults with primary posterior capsulorhexis; comparison of hydrogel and silicone intraocular lenses with round edges after 2 years. J Cataract Refract Surg 2003; 29:955-960 3. Peng Q, Visessook N, Apple DJ, et al. Surgical prevention of posterior capsule opacification. Part 3: intraocular lens optic barrier effect as a second line of defense. J Cataract Refract Surg 2000...
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