眼科手術入院時検査にて新型コロナウイルス感染症（COVID-19）陽性であった3症例

Three cases of COVID-19 positive patients detected during preoperative screening for ophthalmic surgery

要約　目的：2023年5月に新型コロナウイルス感染症（COVID-19）が感染症法上2類相当から5類へ変更されたのち，当科において入院時にCOVID-19抗原検査陽性であった症例について報告する。

症例：2023年5〜12月，三重大学医学部附属病院眼科で入院時にCOVID-19抗原検査を受けた7例のうち，検査結果が陽性であった3例について報告する。

［症例1］63歳，男性。他院にて左眼裂孔原性網膜剝離と診断され，術前検査結果が陽性であったため当院へ紹介された。発熱や呼吸器症状は認めず，眼科的緊急性が高かったことから，入院当日に陰圧手術室にて個人用防護具を着用し硝子体手術を施行した。

［症例2］3歳，男児。左眼続発緑内障。左眼圧が39mmHgと上昇したため全身麻酔下での手術を予定していたが，付き添い家族が検査結果陽性となったことを契機に患児本人も陽性となった。これにより約1か月間手術を延期し，全身状態が安定したのちに全身麻酔下で線維柱帯切開術を施行した。

［症例3］84歳，男性。右眼白内障。入院2週間前に検査結果陽性と判明した。解熱したため予定通り入院したが，呼吸器症状がみられたため白内障手術を中止し，当院呼吸器内科を受診した。その後，集中治療室へ入室し治療を受けたが，入院3日目に永眠した。

結論：COVID-19が5類感染症に分類されたことにより，入院患者全員を対象とした抗原検査は行われなくなった。一方，検査陽性例に対しては，眼科医が個々の症例における治療緊急性を適切に判断し，感染症対策を講じる必要がある。

Abstract　Purpose：To evaluate patients who tested positive for Coronavirus Disease 2019（COVID-19）during antigen testing at the time of admission to our department following the reclassification of COVID-19 as a Category 5 infectious disease in May 2023.

Cases：Three of the seven patients who underwent antigen testing upon admission to the Department of Ophthalmology at Mie University Hospital between May and December 2023 tested positive for COVID-19. This report describes these three cases.

Case 1 was a 63-year-old man diagnosed with rhegmatogenous retinal detachment in the left eye at another hospital was referred to our hospital after testing positive for COVID-19 during pre-operative screening. The patient exhibited no fever or respiratory symptoms. Therefore, vitrectomy was performed on the day of admission in a negative-pressure operating room using personal protective equipment owing to the urgent need for ophthalmic intervention.

Case 2 was a 3-year-old boy with secondary glaucoma in the left eye who presented with an elevated intraocular pressure of 39 mmHg. Surgery under general anesthesia was scheduled. However, surgery was postponed for approximately one month as the patient tested positive for COVID-19 after a family member accompanying him tested positive for COVID-19. Trabeculotomy was performed successfully under general anesthesia after his general condition had stabilized.

Case 3 was an 84-year-old man scheduled to undergo cataract surgery in his right eye who tested positive for COVID-19 two weeks prior to admission, but had achieved a normothermic state. He was admitted on the scheduled date of surgery；however, cataract surgery was cancelled as respiratory symptoms were observed. He was referred to the Department of Respiratory Medicine and subsequently admitted to the intensive care unit. The patient died on the third day of hospitalization despite receiving treatment.

Conclusion：Routine antigen testing has been discontinued for all inpatients since the reclassification of COVID-19 as a Category 5 infectious disease. Nevertheless, ophthalmologists must carefully assess the urgency of treatment and implement appropriate infection control measures for patients who test positive.