Abstract Purpose: To report the perceptions and actions undertaken by members of the Mexican Society of Ophthalmology (SMO) during the first months of the COVID-19 pandemic. The paper focuses on the association between professional characteristics and the extent of implementation of the recommendations published by the SMO. Methods: An online survey at Google® Forms was sent via email to ophthalmologists registered with the SMO. A total of 3,296 questionnaires were sent. Two principal variables were selected for the purpose of analyzing the exploratory hypotheses: seniority of the respondents and type of practice. Results: A total of 363 replies were obtained (11.01%). At the time of the survey, 223 ophthalmologists (61.3%) were continuing to see patients in their clinics, while 140 participants (38.5%) had ceased all activities. The main reason for stopping clinical work was the fear that the practices would become transmission hubs. There was a statistical association between higher seniority and discontinuing patient care (p = 0.002). A total of 107 (29.7%) participants continued performing surgical procedures. Participants with less than 10 years of experience had a higher probability of engaging in emergency surgical procedures (p = 0.04). The most commonly employed preventive measure was the use of face masks for patients, followed by the use of N95 respirators by doctors. Conclusion: The majority of the participants maintained their clinical work; in contrast, less than a third continued surgical activities. There was great diversity in the actions taken and in the adoption of SMO recommendations. The use of personal protective equipment was the most employed security measure.

Resumen Objetivo: Analizar el impacto de la emergencia sanitaria por COVID-19 en las percepciones y acciones de los miembros de la Sociedad Mexicana de Oftalmología (SMO) durante los primeros meses. Se describe la asociación entre las características profesionales y la implementación de medidas de bioseguridad publicadas por la SMO Método: Encuesta en línea, mediante Google® Forms, enviada por correo electrónico a oftalmólogos registrados en la SMO. Se enviaron en total 3296 cuestionarios. Se codificaron dos variables principales para analizar las hipótesis exploratorias: experiencia de los encuestados y tipo de práctica. Resultados: Se obtuvieron 363 respuestas (11.01%). Al momento de la encuesta, 223 (61.3%) oftalmólogos continuaban la atención clínica y 140 (38.5%) habían cesado toda actividad. La principal razón para detener el trabajo clínico fue el temor a convertirse en centros de transmisión. Hubo una asociación entre la mayor experiencia y la interrupción de la atención al paciente (p = 0.002). Continuaron realizando cirugías 107 (29.7%) oftalmólogos. Los participantes con menos de 10 años de experiencia tenían mayor probabilidad de realizar cirugías de emergencia (p = 0.04). La medida de seguridad más empleada fue el uso de cubrebocas en los pacientes, seguido del uso de mascarillas N95 por parte de los médicos. Conclusiones: La mayoría de los participantes mantuvieron su trabajo clínico, pero menos de un tercio continuaron las actividades quirúrgicas. Hubo una gran diversidad en las acciones emprendidas y en la adopción de las recomendaciones de la SMO. El uso de equipo de protección personal fue la acción más frecuente entre los participantes.

RESUMO Identificar e classificar as informações disponíveis sobre o COVID-19 e o tratamento oftalmológico de acordo com o nível de evidência, dentro de quatro tópicos principais de interesse: evidência do vírus nas lágrimas e na superfície ocular, infecção pela via conjuntival, manifestações oculares e recomendações de melhores práticas. Foi realizada uma revisão estruturada no PubMed, ScienceDirect, LILACS, SciELO, Biblioteca Cochrane e Google Scholar no COVID-19 e oftalmologia. A planilha de Níveis de Evidência 2011 do Oxford Centre for Evidence Based Medicine 2011 foi usada para avaliações de qualidade. Mil e dezoito itens foram identificados na busca; Foram incluídos 26 registros na síntese qualitativa, que incluiu 6 revisões de literatura, 10 séries de casos ou estudos transversais, 4 relatos de casos e 6 descrições de intervenções. Dezessete dos 26 registros (65%) foram classificados como nível 5 no sistema de classificação da metodologia Oxford CBME, o restante foi no nível 4. As evidências geradas no COVID-19 e na oftalmologia até o momento são limitadas, embora isso seja compreensível dadas as circunstâncias. Tanto a possível presença de partículas virais em lágrimas e conjuntiva quanto o potencial de transmissão conjuntival permanecem controversos. As manifestações oculares não são frequentes e podem se assemelhar a infecção viral da superfície ocular. A maioria das recomendações baseia-se nas estratégias implementadas pelos países asiáticos durante surtos anteriores de coronavírus. Há necessidade de estudos aprofundados avaliando essas estratégias no cenário da SARS-CoV-2. Enquanto isso, os planos para a aplicação dessas medidas devem ser implementados com cautela, levando em consideração o contexto de cada país e submetidos a auditorias periódicas.

ABSTRACT To identify and classify available information regarding COVID-19 and eye care according to the level of evidence, within four main topics of interest: evidence of the virus in tears and the ocular surface, infection via the conjunctival route, ocular manifestations, and best practice recommendations. A structured review was conducted in PubMed, ScienceDirect, LILACS, SciELO, the Cochrane Library and Google Scholar on COVID-19 and ophthalmology. The Oxford Centre for Evidence Based Medicine 2011 Levels of Evidence worksheet was used for quality assessments. 1018 items were identified in the search; 26 records were included in the qualitative synthesis, which encompassed 6 literature reviews, 10 case series or cross-sectional studies, 4 case reports, and 6 intervention descriptions. Seventeen out of 26 records (65%) were categorized as level 5 within the Oxford CBME methodology grading system, the rest were level 4. The evidence generated on COVID-19 and ophthalmology to date is limited, although this is understandable given the circumstances. Both the possible presence of viral particles in tears and conjunctiva, and the potential for conjunctival transmission remain controversial. Ocular manifestations are not frequent and could resemble viral infection of the ocular surface. Most recommendations are based on the strategies implemented by Asian countries during previous coronavirus outbreaks. There is a need for substantive studies evaluating these strategies in the setting of SARS-CoV-2. In the meantime, plans for applying these measures must be implemented with caution, taking into account the context of each individual country, and undergo regular evaluation.

To identify and classify available information regarding COVID-19 and eye care according to the level of evidence, within four main topics of interest: evidence of the virus in tears and the ocular surface, infection via the conjunctival route, ocular manifestations, and best practice recommendations. A structured review was conducted in PubMed, ScienceDirect, LILACS, SciELO, the Cochrane Library and Google Scholar on COVID-19 and ophthalmology. The Oxford Centre for Evidence Based Medicine 2011 Levels of Evidence worksheet was used for quality assessments. 1018 items were identified in the search; 26 records were included in the qualitative synthesis, which encompassed 6 literature reviews, 10 case series or cross-sectional studies, 4 case reports, and 6 intervention descriptions. Seventeen out of 26 records (65%) were categorized as level 5 within the Oxford CBME methodology grading system, the rest were level 4. The evidence generated on COVID-19 and ophthalmology to date is limited, although this is understandable given the circumstances. Both the possible presence of viral particles in tears and conjunctiva, and the potential for conjunctival transmission remain controversial. Ocular manifestations are not frequent and could resemble viral infection of the ocular surface. Most recommendations are based on the strategies implemented by Asian countries during previous coronavirus outbreaks. There is a need for substantive studies evaluating these strategies in the setting of SARS-CoV-2. In the meantime, plans for applying these measures must be implemented with caution, taking into account the context of each individual country, and undergo regular evaluation.

Identificar e classificar as informações disponíveis sobre o COVID-19 e o tratamento oftalmológico de acordo com o nível de evidência, dentro de quatro tópicos principais de interesse: evidência do vírus nas lágrimas e na superfície ocular, infecção pela via conjuntival, manifestações oculares e recomendações de melhores práticas. Foi realizada uma revisão estruturada no PubMed, ScienceDirect, LILACS, SciELO, Biblioteca Cochrane e Google Scholar no COVID-19 e oftalmologia. A planilha de Níveis de Evidência 2011 do Oxford Centre for Evidence Based Medicine 2011 foi usada para avaliações de qualidade. Mil e dezoito itens foram identificados na busca; Foram incluídos 26 registros na síntese qualitativa, que incluiu 6 revisões de literatura, 10 séries de casos ou estudos transversais, 4 relatos de casos e 6 descrições de intervenções. Dezessete dos 26 registros (65%) foram classificados como nível 5 no sistema de classificação da metodologia Oxford CBME, o restante foi no nível 4. As evidências geradas no COVID-19 e na oftalmologia até o momento são limitadas, embora isso seja compreensível dadas as circunstâncias. Tanto a possível presença de partículas virais em lágrimas e conjuntiva quanto o potencial de transmissão conjuntival permanecem controversos. As manifestações oculares não são frequentes e podem se assemelhar a infecção viral da superfície ocular. A maioria das recomendações baseia-se nas estratégias implementadas pelos países asiáticos durante surtos anteriores de coronavírus. Há necessidade de estudos aprofundados avaliando essas estratégias no cenário da SARS-CoV-2. Enquanto isso, os planos para a aplicação dessas medidas devem ser implementados com cautela, levando em consideração o contexto de cada país e submetidos a auditorias periódicas.

ABSTRACT Infectious corneal ulcers are an ophtalmological emergency that threatens sight and eyes integrity, causing blindness in 1.5-2 million of people per year. The objective was to determinate epidemiological pattern, risk factors and treatment efficiency in patients with corneal ulcer in Fundacion Vision from 2015 to 2017. This was a prospective cohort study, 53 patients with infectious corneal ulcer were examined in Fundacion Vision from 2015 to 2017, and were followed for at least 4 months. Predominance of males (69.8%), aged 45-65 years (49.1%), married (54.7%), low socio-economic status (56.6%), farmers (26.4%), with a history of corneal trauma (69.8%) or contact lenses users (17%) were found. The etiological agent was bacterial in 49.1% and mycotic in 37.7%; the most accurate treatment for those of bacterial origin was fortified eye drops of Cefazolin+Gentamicin and Natamycin/Fluconazole in case of being fungal. The evolution was favorable in 90.9% and 80.0% of the bacterial and mycotic infections, respectively. High risk groups detected were male patients, farmers, low socio-economic status, with a history of corneal trauma or contact lenses user. On the other hand, the effectiveness of the treatment was greater than 80%, and the infections were mostly caused by bacterial pathogens.

RESUMEN Las úlceras corneales de origen infeccioso son una emergencia oftalmológica que amenaza la visión y la integridad estructural del ojo, causando ceguera en 1,5 a 2 millones de casos al año por lo que requiere tratamiento inmediato. El objetivo fue determinar el patrón epidemiológico, factores de riesgo y efectividad del tratamiento en pacientes con úlcera corneal en la Fundación Visión en el periodo 2015-2017. Estudio de cohorte prospectivo donde se evaluó 53 pacientes con úlcera corneal de causa infecciosa que consultaron en la Fundación Visión en el periodo 2015-2017, y tuvieron un seguimiento mínimo de 4 meses. Se encontró un predominio del sexo masculino (69,8%), edad 45-65 años (49,1%), casados (54,7%), de condición socioeconómica baja (56,6%), agricultores (26,4%), con antecedente de traumatismo corneal (69,8%) o uso de lentes de contacto (17%). El agente etiológico fue bacteriano en el 49,1% y micótico en el 37,7%; para los de origen bacteriano el tratamiento más empleado fueron colirios fortificados de Cefazolina + Gentamicina y Natamicina/Fluconazol en caso de ser micótico. La evolución fue favorable en 90,9% y 80,0% de los bacterianos y micóticos, respectivamente. Los grupos de riesgo detectados fueron pacientes varones, agricultores, de condición socioeconómica baja, con antecedente de traumatismo corneal o uso de lentes de contacto. La efectividad del tratamiento utilizado fue mayor al 80%, siendo en su mayoría patógenos bacterianos.