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Thank-you to the authors for sharing their departmental protocol based current international research and recommendations . We have put in place many of the precautions outlined however wished to share our recent experience with regard to intravitreal injections (IVI), and additional measures put in place as a result.
IVIs have continued in our service for sight threatening pathology throughout the UK government lockdown of the past 8 weeks. Patients have self-isolated for 7 days prior to their procedure and are screened for symptoms of COVID19 or contacts before attendance. Arriving at our facility they wash their hands, don a surgical mask and have their temperature, oxygen saturations and blood pressure checked. Social distancing is maintained in waiting areas by blocking alternate seats as mentioned.
For the procedure itself the patient is draped and injectors wear sterile gloves, a theatre gown and a fluid resistant surgical mask as per national guidance .
There was no protocol to routinely test patients attending for IVI at our units for coronavirus, however tests were performed on four consecutive injection lists on 4th and 5th May. 48 patients were tested with a mean age of 76 years (range 54-92). 2 (4%) tested positive despite being asymptomatic. They were asked not to attend and will be rescheduled. 4 (13%) decided not to attend voluntarily.
As mentioned by the authors retinal services tend to serve an elderly population with a...
As mentioned by the authors retinal services tend to serve an elderly population with a high prevalence of co-morbidities. This puts them at high risk of significant morbidity and mortality from COVID-19. Although a small opportunistic sample our observations suggest that simply isolating and screening symptomatic patients cannot guarantee a list free from the risk of potential transmission amongst this at risk population.
As a result of the above and in addition to the measures outlined we feel we should now swab test all patients 3 days prior to their attendance.
Furthermore, given the close contact inherent in performing injections and in line with recommendations from our Hong Kong colleagues based on experience from the SARS outbreak  we feel that IVIs should be considered high risk procedure for transmission and staff supported in wearing personal protective equipment that makes them feel safe. This is generally felt to be a filtering face piece (FFP3) mask and a protective visor in addition to a surgical gown and gloves.
We look forward to hearing from colleagues elsewhere as to how they approach this issue.
 Safadi K, Kruger J, Chowers I, Solomon A, Amer R, Aweidah H et al. Ophthalmology practice during the COVID-19 pandemic. BMJ Open Ophthalmology. 2020;5(1):e000487.
 Public Health England. Recommended PPE for healthcare workers by secondary care inpatient clinical setting, NHS and independent sector. 2020 p. 33.
 Chan W, Liu D, Chan P, Chong K, Yuen K, Chiu T et al. Precautions in ophthalmic practice in a hospital with a major acute SARS outbreak: an experience from Hong Kong. Eye. 2005;20(3):283-289.