Latar Belakang : COVID-19 merupakan masalah kesehatan yang dinyatakan sebagai pandemi oleh WHO. Beberapa penelitian melaporkan tentang hubungan SARS-CoV-2 dengan kelainan pada mata. Pada era pandemi, pengelolaan pasien sakit mata harus hati-hati untuk mencegah penularan petugas medis. Laporan kasus ini menyajikan pengelolaan perforasi kornea pasien terkonfirmasi COVID-19.
Metode : Diagnosis ditegakkan berdasarkan anamnesis, pemeriksaan fisik dan oftalmologi dengan pemeriksaan penunjang lainnya.
Laporan Kasus : Perempuan berusia 54 tahun dirujuk dengan keluhan keluar darah pada mata kiri sejak 17 jam sebelum sampai RS. Keluhan batuk atau demam 14 hari sebelumnya disangkal. Pada pemeriksaan oftalmologi didapatkan perforasi kornea mata kiri disertai prolaps isi bola mata (iris, vitreus dan choroid). Pada pemeriksaan penunjang didapatkan foto rontgen thorax normal, rapid test covid-19 reaktif dan hasil positif pada PCR dari swab nasofaring. Seluruh staf medis menggunakan alat pelindung diri (APD) tingkat tiga dalam melakukan pemeriksaan fisik maupun penunjang. Dari hasil anamnesis pemeriksaan fisik dan penunjang, pasien didiagnosis dengan perforasi kornea spontan mata kiri dan terkonfirmasi COVID-19. Pasien direncanakan untuk eviserasi mata kiri dengan anestesi umum dan saat tindakan operator dan seluruh staf ruang operasi menggunakan alat pelindung diri (APD) tingkat tiga. Setelah operasi dilakukan, pasien kemudian dirawat di ruang isolasi khusus COVID-19. Swab nasofaring dilakukan ulang sehari setelah operasi dan keesokan harinya. Dua hari setelah operasi, pasien dipulangkan dan isolasi mandiri di rumah
Kesimpulan: Laporan kasus ini menunjukkan manajemen perforasi kornea pada pasien terkonfirmasi COVID-19 yang dilakukan sesuai alur khusus termasuk pada pemeriksaan fisik dan penunjang, penegakkan diagnosis oftalmologi dan COVID-19, prosedur pembedahan dan perawatan pasca operasi.
Kata Kunci : SARS-CoV-2, Perforasi Kornea, APD, PCR, Eviscerasi
Introduction: Corona-Virus-Disease-2019 (COVID-19) is an important health problem that was defined as a pandemic by the World Health Organization (WHO). There are few reports on the association of SARS-CoV-2 with ocular abnormalities. In the pandemic era, management of ocular patients should be more careful to prevent transmission to medical staff. This report presenting the management of corneal perforation in confirmed COVID-19 patients.
Method: The diagnosis was established based on history taking, physical and ophthalmology examination with other ancillary tests.
Case Report : 54-year-old female patient referred with complaints of left eye bleeding since 17 hours ago. This patient never complaint about cough or fever 14 days before admission. From the ancillary test (complete blood count and chest x-ray are within normal limit, reactive rapid test for COVID-19, positive result of PCR nasopharynx). The patient was diagnosed with spontaneous corneal perforation on the left eye with COVID-19 confirmed. The evisceration procedure with general anesthesia was performed with exceptional precaution. Operator and all operating room staff wear the 3rd level of personal protective equipment (PPE). The surgery was successfully done and the patient then hospitalized in the COVID-19 isolated room. Nasopharynx swab performs the day after surgery and the next day after the first swab. Two days after surgery, the patient was discharged and followed by a self-isolation procedure.
Conclusion: This case report presenting corneal perforation management in confirmed COVID-19 patients should be performed under a firm scheme including physical and ophthalmological examinations, ophthalmology and COVID-19 diagnosis enforcement, ancillary test, surgery procedure, post-operative care and also PPE utilization.
Keyword : SARS-CoV-2, Corneal Perforation, 3rd level PPE, PCR, Evisceration
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