COVID-19陽性の裂孔原性網膜剝離3例に対する手術経験

Retinal detachment surgery in patients with COVID-19: A report of three cases

要約　目的：新型コロナウイルス感染症（COVID-19）の流行下では，治療だけではなく，医療従事者への感染予防を行ったうえで診療体制を維持することも求められる。今回，術前にCOVID-19陽性が確認された裂孔原性網膜剝離（RRD）手術症例を3例経験したので報告する。

症例1：21歳，男性。各種眼科検査と診察が終了した後にCOVID-19陽性が判明。担当医を含む複数名が濃厚接触者となった。手術部とは事前にゾーニングなどの術中感染対策を検討していたため，同日中に全身麻酔下で網膜復位術を施行。

症例2：58歳，女性。他院からCOVID-19陽性RRDのため手術依頼あり。院内感染対策室，呼吸器内科と連携し，翌日当院へ転院搬送。来院時より十分な感染対策を行い，局所麻酔下で硝子体手術を施行。濃厚接触者は発生しなかった。

症例3：28歳，女性。数か月前から視機能低下を自覚。網膜下索状物を伴うRRDで，全身麻酔下での網膜復位術を後日予定するも，同居家族からCOVID-19に感染。隔離期間終了後に網膜復位術を全身麻酔下で施行。全例で医療従事者への感染は確認されず，術後良好な経過が得られた。

結論：COVID-19流行下ではRRD患者がCOVID-19陽性である可能性を念頭に置き，術前から医療従事者が感染対策を行い，各部署と連携して適切な時期に手術加療を行うことが重要である。

Abstract　Introduction：In addition to providing treatment, preventing infection among healthcare workers is important to maintain optimal functioning of medical care systems during the coronavirus disease（COVID-19）pandemic. We report three cases of rhegmatogenous retinal detachment（RRD）surgery performed in patients preoperatively confirmed to be COVID-19 positive.

Case 1：A 21-year-old man tested positive for COVID-19 testing following ophthalmologic evaluation and consultation. Several healthcare workers had come in close contact with the patient. Intraoperative infection control measures had been discussed with the surgical department in advance；therefore, a scleral buckle surgery was performed under general anesthesia on the same day.

Case 2：A 58-year-old woman who showed positive results on COVID-19 testing was referred from another hospital for RRD surgery. The patient was transferred to our hospital the following day after coordination with the hospital infection control room and the Department of Respiratory Medicine. Adequate infection control measures were adopted from the time of arrival, and vitrectomy was performed under local anesthesia. The patient did not come in close contact with any of the hospital personnel.

Case 3：A 28-year-old woman presented with a several-month history of declining visual function. She was diagnosed with RRD and was subsequently scheduled to undergo surgery under general anesthesia；however, she tested positive for COVID-19. She underwent a scleral buckle procedure under general anesthesia after completion of the isolation period. The patient did not come in close contact with any of the hospital personnel. No infection was observed in any healthcare worker in all three cases, and all patients underwent successful retinal surgery.

Conclusions：It is essential to test patients with RRD. Appropriate infection control measures are important among healthcare professionals, and interdepartmental collaboration is necessary to provide suitable surgical treatment.